Documento de consenso sobre tabaquismo y riesgo vascular.

Consensus statement on smoking and vascular risk About 22% of the Spanish population are daily smokers. Men are more likely to smoke than women. In Spain, women between 15-25 years of age smoke as much or more than men. Every smoker should be assessed for: physical dependence on nicotine (Fagerström test), social and psychological dependence (Glover Nilsson test), level of motivation to quit (Richmond test), probability of therapy success (Henri-Mondor and Michael-Fiore tests), and stage of behavioral change development (Prochaska and DiClementi). Advice on smoking cessation is highly cost-effective and should always be provided. Smoking is an enhancer of cardiovascular risk because it acts as a pathogen agent in the development of arteriosclerosis and is associated with ischemic heart disease, stroke, and peripheral artery disease. Smoking increases the risk of chronic lung diseases (COPD) and is related to cancers of the lung, female genitalia, larynx, oropharynx, bladder, mouth, esophagus, liver and biliary tract, and stomach, among others. Combined oral contraceptives should be avoided in women smokers older than 35 years of age due to the risk of thromboembolism. In smoking cessation, the involvement of physicians, nurses, psychologists, etc. is important, and their multidisciplinary collaboration is needed. Effective pharmacological treatments for smoking cessation are available. Combined treatments are recommended when smoker's dependence is high. For individuals who are unable to quit smoking, a strategy based on tobacco damage management with a total switch to smokeless products could be a less dangerous alternative for their health than continuing to smoke.

[Cardiometabolic effects of weight loss]. / Efectos cardiometabólicos de la pérdida de peso.

The prevalence of overweight and obesity, and, consequently, associated comorbidities, is increasing significantly worldwide. The guidelines recommend a percentage of weight loss> 5% to achieve beneficial effects on metabolic comorbidities associated with obesity. Furthermore, greater weight losses (> 10%) produce more significant improvements, and may even produce remission of some of these comorbidities. In this chapter, we review the evidence of the effect of weight loss through different strategies (lifestyle intervention, pharmacological treatment, or bariatric surgery) on the main cardiometabolic pathologies associated with excess adipose tissue (type 2 diabetes, high blood pressure, dyslipidemia, metabolic dysfunction-associated steatotic liver disease, inflammation, cardiovascular diseases, and mortality).

Impacto de la pandemia COVID 19 en los factores de riesgo cardiovasculares y en la salud mental en usuarios de consulta privada cardiológica

Antecedentes: La pandemia de Covid-19 se ha convertido en uno de los desastres de salud, económicos y sociales más grandes de la historia de la humanidad. En este contexto se evidencia un aumento sustancial de trastornos emocionales diversos como, la ansiedad, la depresión, estrés y agotamiento emocional. Es preocupante el impacto que puede representar en los pacientes con factores de riesgo cardiovasculares (FRCV) durante la emergencia sanitaria. Objetivo: Analizar el impacto de la pandemia Covid 19 en los FRCV y en la salud mental en usuarios de consulta privada cardiológica. Método: Estudio observacional, analítico de corte transversal. Población objetivo 100 usuarios atendidos en consulta privada cardiológica, todos con consentimiento informado. Muestra no probabilística por conveniencia. Se realizó encuesta DASS-21 intra pandemia Covid 19 para medición de depresión, ansiedad y estrés. Medición antropométrica y exámenes de glicemia, insulinemia, hemoglobina glicosilada (HbA1c), perfil lipídico y presión arterial, para los periodos pre pandemia (PP) e intra pandemia (IP) Covid 19. Se usó software Stata para el análisis estadístico de medidas de tendencia central y el análisis bivariado con prueba de Chi2. Resultados: La muestra incluyó 100 usuarios: 51,5% de género femenino, y el promedio de edad fue 60,8 ±13,7 años. El nivel socioeconómico (NSE) fue Alto en 55,5%. El 63,6% presentaban nivel de escolaridad enseñanza superior (NEES). Al analizar ambos periodos, PP e IP, los resultados con mayor relevancia fueron: presión arterial (PA) alterada 16,6% en PP y 22,9% en IP; sobrepeso/obesidad 65,8% en PP y 70,7% en IP; HbA1c 16,6% PP y 31,9% en IP; insulinemia alterada 15,7% PP y 21% en IP; colesterol no HDL alterado 50,5% en PP y 52,7% en IP; índice HOMA alterado 44,5% en PP y 54,3% en IP. Se evidenció un importante aumento en trastornos de salud mental en IP que fueron depresión leve/moderada en 20% y depresión severa/extremadamente severa en 11%; ansiedad leve/moderada 25% y ansiedad severa/extremadamente severa 22%, estrés leve/moderado 21% y estrés severo/extremadamente severo 18%. Conclusiones: En el periodo IP hubo una alteración estadísticamente significativa en las variables clínicas como PA, HbA1c, índice HOMA, insulinemia, colesterol noHDL y sobrepeso/obesidad. En el periodo IP hubo un alto porcentaje de depresión, ansiedad y estrés, especialmente en mujeres. La pandemia por Covid 19 ha tenido impacto en los FRCV y en la salud mental en usuarios del sistema privado de salud.

Background: The Covid-19 pandemic has become one of the largest health, economic, and social disasters in human history. In this context, there has been a substantial increase in various emotional disorders such as anxiety, depression, stress, and emotional exhaustion. Given these issues, there is concern about the impact this may have on patients with cardiovascular risk factors (CVRF) during this health emergency. Objective: To analyze the impact of the COVID-19 pandemic on CVRF and mental health in subjects undergoing private cardiology consultation. Method: Observational, analytical, cross-sectional study. The target population consisted of 100 users attending a private cardiology consultation, all of them giving informed consent, with anon-probabilistic convenience sample. DASS-21 survey was conducted during the COVID-19 pandemic to evaluate depression, anxiety, and stress. Anthropometric measurements and tests for glycemia, insulinemia, glycosylated hemoglobin (HbA1c), lipid profile, and blood pressure were performed for the pre-pandemic (PP) and during-pandemic (IP) COVID-19 periods. Statistical analysis, measures of central tendency, and bivariate analysis with Chi2 test. was performed using a Stata software package. Results: The sample consisted of 100 subjects, 51.5% female, with an average age of 60.8 ± 13.7 years. Subjects had a high socio-economic Level (SEL)in 55.5% and higher education level in 63.6%. Comparing PP and IP periods, the most relevant results, re were respectivly: altered blood pressure (BP) 16.6% vs 22.9%, overweight/obesity 65.8% vs 70.7%, HbA1c 16.6% vs 31.9%, altered insulinemia 15.7% vs 21%, altered non-HDL cholesterol 52.7%, vs 50.5%, and HOMA index 44.5% vs 54.3%. A significant increase in mental health disorders in IP was evidenced, which were: mild/moderate depression 20%, and severe/extremely severe depression 11%; mild/moderate anxiety 25%, and severe/extremely severe anxiety 22%, mild/moderate stress 21%, and severe/ extremely severe stress 18%. Conclusions: In the IP phase there was a statistically significant alteration in clinical variables such as BP, HbA1c, HOMA index, insulinemia, non-HDL cholesterol, and overweight/ obesity. Also, a high percentage of depression, anxiety, and stress was observed. The COVID-19 pandemic has impacted CVR and mental health in subjects being cared for in the private health system.

Evaluación de la condición física y salud escolar en niños y niñas de la provincia de San Luis, Argentina / Assessment of children's physical fitness and school health in the province of San Luis, Argentina

Introducción. La evaluación de la condición física (CF), junto con otros indicadores de salud, es una estrategia utilizada para conocer el estado actual de los escolares. El principal objetivo fue medir en escolares sanluiseños el estado de salud actual, los niveles de CF y construir tablas de referencias de CF. Población y métodos. Escolares entre 9 y 12 años de edad (ambos sexos) fueron evaluados con dos indicadores de salud: índice de masa corporal y presión arterial. La CF fue medida con la batería ALPHA-Fitness. El orden de las pruebas fue el siguiente: tensión arterial, masa corporal, estatura, longitud de pie y mano, salto en longitud, velocidad en 30 metros, agilidad 4 × 10 m y la prueba de ida y vuelta en 20 metros. Se calculó el índice de masa corporal (IMC) y la maduración biológica. Resultados. Fueron evaluados 15548 escolares. Los valores promedios fueron presión arterial sistólica 101 ± 10 mmHg y diastólica 66 ± 7 mmHg; IMC 20,2 ± 4,3 kg/m2. Para la CF fueron las siguientes: componente cardiorrespiratorio VO2 máx. 39,87 ± 3,2 ml/kg/min y velocidad alcanzada en la prueba de ida y vuelta en 20 m 8,9 ± 0,6 km/h; componente neuromuscular; salto en longitud: 120,6 ± 23,9 cm, velocidad 30 m: 6,56 ± 0,85 s, agilidad 4 × 10 m: 15,17 ± 1,82 s. El rendimiento siempre fue superior en el grupo masculino (p <0,001). Conclusión. Los escolares mostraron niveles saludables de presión arterial. El 50 % de la muestra fue clasificada con sobrepeso u obesidad según el IMC. En ambos sexos, se observaron bajos niveles de CF. Por primera vez, se elaboraron tablas de referencia de CF en escolares sanluiseños

Introduction. The assessment of physical fitness (PF), is useful strategy to know the current status of schoolchildren. Our primary objective was to measure the current health status and PF levels of schoolchildren in San Luis and to develop PF reference tables. Population and methods. Schoolchildren aged 9 to 12 years (boys and girls) were assessed based on 2 health indicators: body mass index and blood pressure. PF was measured using the ALPHA-Fitness test battery. Blood pressure, body mass, height, foot and hand length, standing long jump, 30 m sprint, 4 × 10 m agility test, and 20 m shuttle run test were assessed. The body mass index (BMI) and biological maturation were estimated. Results. A total of 15 548 schoolchildren were assessed. Average systolic blood pressure was 101 ± 10 mmHg and diastolic blood pressure, 66 ± 7 mmHg; BMI: 20.2 ± 4.3 kg/m2. Average PF was, in the cardiorespiratory component, VO2 max.: 39.87 ± 3.2 mL/kg/min and speed reached during the 20 m shuttle run test: 8.9 ± 0.6 km/h; in the musculoskeletal component, standing long jump: 120.6 ± 23.9 cm, 30 m sprint: 6.56 ± 0.85 s, 4 × 10 m agility test: 15.17 ± 1.82 s. The performance was better in the boys group (p < 0.001). Conclusion. Blood pressure was normal. Fifty percent of the sample was overweight or obese as per their BMI. Both boys and girls showed low PF levels. PF reference tables for schoolchildren from San Luis were developed for the first time.

[Cardiovascular prevention in primary care in crisis situations: multicenter comparative study before, during and after the SARS-COVID-19 pandemic]. / Prevención cardiovascular en Atención Primaria en situación de crisis: estudio comparativo multicéntrico antes, durante y después de la pandemia por SARS-COVID-19.

OBJECTIVE: To assess whether the appearance of a crisis situation such as the one caused by the SARS-COV-2 pandemic, together with the organizational changes adopted in Primary Care, have influenced the implementation of cardiovascular preventive activities in patients aged 40 to 74 years. DESIGN: Retrospective multicenter descriptive study for three years (2019-2022) in Primary Care. SETTING: 35 health centers of the Primary Care of the Northern Assistance Directorate of Madrid. PARTICIPANTS: 1008 patients of both sexes between 40 and 74 years with diagnosed of hypertension, Diabetes Mellitus and/or dyslipidemia. METHOD: The variables analyzed from the computerized clinical history were lifestyle activities (consumption of tobacco, alcohol, consumption of Mediterranean diet and exercise) considering 3 of the 4 parameters optimal; examination data (blood pressure record) and analytical record (glycemia, hbA1c, total cholesterol, HDL, LDL)considering 4 of the 5 parameters optimal. Differences are analyzed between based pre-pandemic (03/15/2019-03/14/2020), pandemic (03/15/2020-03/14/2021), and transition (03/15/2022-03/14/2022). STATISTICAL ANALYSIS: MC Nemar's test to compare the main variables between the study periods. RESULTS: Data from 1008 patients are collected. The registration of preventive activities on lifestyle was 180 patients (17.9%) (IC95%: 0,155-0,204) in pre-pandemic, 29 patients (2.9%) (IC 95%: 0,019-0,041) in pandemic and 55 patients (5.5%) (IC 95%: 0,041-0,070) in the transition stage (p < 0.05). Exploration was registered in 393 patients (39%) (IC95%: 0,360-0,421) in the pre-pandemic, 133 patients 13,2% (IC 95%: 0,112-0,154) in the pandemic, and 218 patients (21,6%) (IC 95%: 0,191-0,243) in the transition (p < 0.05). The analytical record was 33 patients (3.3%) (IC955: 0,023-0,046), 10 patients (1%) (IC95%: 0,005-0,018) and 23 patients (2.3%) (IC95%: 0,015-0,034) respectively in each phase with one (P < 0.05). CONCLUSIONS: Activities on lifestyle, physical examination, and laboratory test as part of the cardiovascular prevention strategy are scarce in the prepandemic period and decrease drastically during the pandemic, at the first level of care.

[Circadian rhythm and blood pressure in patients with ambulatory blood pressure monitoring and its relationship with the risk of cardiovascular events]. / Ritmo circadiano y presión arterial en pacientes con monitorización ambulatoria de la presión arterial y su relación con el riesgo de evento cardiovascular.

INTRODUCTION: Cardiovascular diseases are the group of diseases that cause most deaths worldwide, being arterial hypertension the modifiable risk factor that mostly predisposes to other cardiovascular diseases development. In this regard, ambulatory blood pressure monitoring (ABPM) lets to detect the different changes in blood pressure throughout 24h, known as circadian patterns (dipper, non-dipper, riser or extreme dipper). There may be an association between these patterns and cardiovascular risk, so this study aims to compare cardiovascular risk using the 2 validated scales REGICOR and SCORE in patients with different circadian patterns using ABMP. MATERIAL AND METHODS: Retrospective study of hypertensive patients with ABMP registered between 2015 and 2021 in Alcázar de San Juan and Madridejos. Data were collected from clinical history (arterial hypertension, BMI, comorbidities, and smoking habits) and ABPM records, as well as sociodemographic and analytical variables, cardiovascular risk scales (REGICOR and SCORE) and circadian rhythm variables (dipper, extreme dipper, non-dipper and rise pattern). RESULTS: Two hundred and sixty-nine patients (46.5% female, 64.3±12.6 years old) were included. There were 38.3% with dipper pattern, 10% extreme dipper, 33.1% non-dipper and 18.6% riser. Patients with riser pattern showed higher score on the REGICOR and SCORE scales (34 and 68%, respectively). A significant correlation was established between both scales (Spearman rho: 0.589; p<0.001), but with poor concordance (kappa=0.348 [95% CI 0.271-0.425]). CONCLUSION: ABMP has turned into a very useful tool in the diagnosis and treatment of arterial hypertension. In addition, the circadian patterns of these patients may correlate to the choice of an adequate treatment and correct follow-up.

Clinical profile of severe hypercholesterolemia in 156,000 adults in primary care. / Perfil clínico de la hipercolesterolemia severa en 156.000 adultos en atención primaria.

OBJECTIVE: To examine the frequency of severe hypercholesterolemia (HS) and its clinical profile, and the phenotype of familial hypercholesterolemia (FH), in the primary-care setting in a large health area of the Community of Madrid (CAM). MATERIAL AND METHODS: Multicenter study of subjects with a health card assigned to 69 health centers (Northwest/CAM area). HS was defined as cholesterol ≥300mg/dL or LDL-cholesterol ≥220mg/dL in any analysis performed (1-1-2018 to 12-30-2021); and FH phenotype as c-LDL ≥240mg/dL (≥160mg/dL if lipid-lowering treatment) with triglycerides <200mg/dL and TSH <5µIU/mL. RESULTS: 156,082 adults ≥18years with an available lipid profile were analyzed. 6187 subjects had HS (3.96% of the laboratory tests studied, 95%CI: 3.87-4.06%). The mean evolution time of the diagnosis of hyperlipidemia in the computerized clinical record was 10.8years, 36.5% had hypertension, 9.5% diabetes and 62.9% overweight/obesity. 83.7% were taking lipid-lowering drugs (65.7% low/moderate and 28.6% high/very high intensity). 6.1% had cardiovascular disease (94.2% treated with lipid-lowering agents), with LDL-cholesterol <55, <70 and <100mg/dL of 1.8%, 5.8% and 20.2%, respectively (vs. 1%, 2.3% and 11.2% if no cardiovascular disease). 1600 subjects had FH phenotype (95%CI: 1.03%, 0.98-1.08%). CONCLUSIONS: Four out of 100 patients analyzed in primary care have HS, with high treatment level, but insufficient intensity, and poor achievement of treatment goals. One in 100 have the FH phenotype. The identification of both dyslipidemias by computerized records would allow their more precise and early detection and establish cardiovascular preventive strategies.

Mal control y elevado riesgo cardiovascular en hipertensos de una universidad

Introducción: La hipertensión arterial es una enfermedad de alta prevalencia y complicaciones mortales. Debido a ello, se necesitan un adecuado manejo en la atención primaria y estrategias preventivas y de intervención, como la iniciativa HEARTS en las Américas. Se sabe también que entre los trabajadores de la Universidad de Ciencias Médicas de Matanzas existe una elevada prevalencia de hipertensos. Objetivo: Identificar el comportamiento del control de la enfermedad y la estratificación de riesgo cardiovascular global. Materiales y métodos: Estudio descriptivo transversal en el que se incluyeron los primeros 80 pacientes hipertensos valorados en la consulta de la mencionada institución. Los métodos empleados fueron el analítico-sintético, el inductivo-deductivo, el histórico-lógico y los estadísticos. Resultados: De 808 trabajadores, 276 eran hipertensos, para una prevalencia de 34,1 %. Dentro de los inadecuados estilos de vida, predominó el sedentarismo, con 59 pacientes (73,7 %); 40 de los 80 pacientes estudiados tenían un riesgo cardiovascular cuantitativo igual o mayor del 10 %, mientras que el riesgo cardiovascular cualitativo mostró que 68 (85 %) tenían un riesgo medio o alto. Dentro del daño en órganos diana predominaron las enfermedades cardiovasculares, con un 16,2 %. Conclusiones: La hipertensión arterial sigue siendo uno de los factores de riesgo más importantes de enfermedad cardiovascular y cerebrovascular. Su pesquisa, control y estimación del riesgo constituyen una prioridad de la atención médica a nivel primario.

Introduction: Arterial hypertension is a disease of high prevalence and fatal complications. Due to this, an adequate management is needed in the primary care, and also preventive and intervention strategies, as the HEARTS initiative in the Americas. It is also known that there is a high prevalence of hypertensive patients among the working staff of the Matanzas University of Medical Sciences. Objective: To identify the behavior of disease control and global cardiovascular risk stratification. Materials and methods: Cross-sectional descriptive study in which the first 80 hypertensive patients evaluated in the consultation of the aforementioned institution were included. The methods used were analytical-synthetic, inductive-deductive, historical-logical and statistical. Results: Of 808 workers, 276 were hypertensive, for a prevalence of 34.1%. Among the inadequate lifestyles, sedentary lifestyle predominated, with 59 patients (73.7%); 40 of the 80 patients studied had a quantitative cardiovascular risk equal to or greater than 10%, while qualitative cardiovascular risk showed that 68 (85%) had a medium or high risk. Cardiovascular diseases predominated within target organ damage, with 16.2%. Conclusions: Arterial hypertension continuous to be one of the most important risk factors for cardiovascular and cerebrovascular diseases. Its screening, control and risk assessment are a priority of the medical care at the primary level.

Riesgo cardiovascular en pacientes con esclerosis sistémica / Cardiovascular Risk in Patients with Systemic Sclerosis

Introducción: El riesgo cardiovascular es importante en la evaluación de los pacientes con esclerosis sistémica. Objetivo: Determinar el riesgo cardiovascular en pacientes con esclerosis sistémica. Métodos: Se realizó un estudio transversal y descriptivo en pacientes protocolizados del Servicio de Reumatología, en el período de enero 2020 a enero 2022. Se recogieron variables demográficas, clínicas, y se aplicó la calculadora de riesgo cardiovascular Framingham. Resultados: Se incluyeron 105 pacientes con edad media de 48,6 ± 15,3 años, el grupo más frecuente de 50 a 59 años (36,2 por ciento), predominó el sexo femenino 92,2 por ciento el color de piel blanca (74,3 por ciento), el tiempo de evolución fue mayor a 5 años (66,7 por ciento) con una media de 10,5 ± 9,3. El valor promedio de la escala de gravedad modificada de Medsger fue 5,1 ± 2,7 y el 72,4 por ciento con afectación leve. El fenómeno de Raynaud y la fibrosis pulmonar fueron más frecuentes con un 89,5 por ciento y 55,2 por ciento. El índice de Rodnan en promedio fue de 13,1 ± 8,0 y los reactantes de fase aguda normales en la mayoría. Los factores de riesgo cardiovascular más frecuentes fueron la HTA (30,2 por ciento) y dislipidemia (19,9 por ciento). El índice de masa corporal que predominó fue de peso adecuado (54,3 por ciento). Predominó el riesgo cardiovascular bajo según score de Framingham (86 por ciento). Existieron diferencias significativas entre las medias del tiempo de evolución y el riesgo cardiovascular (10 ± 6,9 frente a 9,6 ± 8,8 frente a 16,9 ± 10,8; p = 0,032). Conclusiones: El riesgo cardiovascular en los pacientes con esclerosis sistémica fue bajo(AU)

Introduction: Cardiovascular risk is important in the evaluation of patients with systemic sclerosis. Objective: To determine the cardiovascular risk in patients with systemic sclerosis. Methods: A cross-sectional and descriptive study was carried out in protocolized patients of Rheumatology Service, from January 2020 to January 2022. Demographic and clinical variables were collected, and Framingham cardiovascular risk calculator was used. Results: One hundred five patients were included with a mean age of 48.6 ± 15.3 years, the most frequent group was 50 to 59 years (36.2percent), female sex (92.2percent) predominated, as well as white skin color (74.3percent). The evolution time was greater than 5 years (66.7percent) with a mean of 10.5 ± 9.3. The average value of modified Medsger severity scale was 5.1 ± 2.7 and 72.4percent had mild involvement. Raynaud's phenomenon and pulmonary fibrosis were more common at 89.5percent and 55.2percent. Rodnan index on average was 13.1 ± 8.0 and the acute phase reactants were normal in the majority. The most frequent cardiovascular risk factors were HBP (30.2percent) and dyslipidemia (19.9percent). The predominant body mass index was adequate weight (54.3percent). Low cardiovascular risk according to Framingham score prevailed (86percent). There were significant differences between the mean duration of evolution and cardiovascular risk (10 ± 6.9 vs. 9.6 ± 8.8 vs. 16.9 ± 10.8; p = 0.032). Conclusions: The cardiovascular risk in patients with systemic sclerosis was low(AU)

Necesidad de calcular el riesgo cardiovascular global en pacientes hipertensos

Ante la amenaza para la salud que representan las enfermedades cardiovasculares, la iniciativa HEARTS, de la Organización Mundial de Salud, brinda apoyo a los países para que fortalezcan las medidas destinadas a prevenir las enfermedades cardiovasculares, como la estratificación del riesgo cardiovascular. Los autores proponen como objetivo fundamentar la necesidad del cálculo del riesgo cardiovascular global en la atención primaria de salud. Para estimar el riesgo cardiovascular global se utilizan dos formas: la cualitativa y la cuantitativa. En esta última, se consideran determinados factores de riesgo cardiovascular, que se expresa en términos de bajo, medio y alto. Existen varios sistemas en diferentes soportes que permiten su uso en diversos escenarios; además, posibilitan planificar el seguimiento y el tratamiento de acuerdo al riesgo. Aunque tienen desventajas, su uso es recomendable para prevenir complicaciones y muerte. El cálculo del riesgo cardiovascular global en pacientes hipertensos es una medida de gran valor para predecir mortalidad, establecer la estrategia terapéutica y planificar el seguimiento de los pacientes. Su uso debe extenderse y consolidarse a todos los niveles de la atención de salud.

Faced with the global health threat posed by cardiovascular diseases, the HEARTS initiative of the World Health Organization supports countries to strengthen measures to prevent cardiovascular diseases, such as cardiovascular risk stratification. The authors propose as an objective to substantiate the need of calculating global cardiovascular risk in primary health care. Two forms are used to estimate global cardiovascular risk: qualitative and quantitative. In the latter, certain cardiovascular risk factors are considered and expressed in terms of low, medium, and high risk. There are several systems and in different supports that allow their use in various scenarios; in addition they make it possible to plan the follow-up and treatment according to risk. Although they have disadvantages, their use is recommended to prevent complications and death. The calculation of global cardiovascular risk in hypertensive patients is a measure of great value for predicting mortality, establishing the therapeutic strategy, and planning patient follow-up. Its use should be extended and consolidated at all levels of health care.

Características metabólicas en infarto agudo de miocardio

Introducción: las alteraciones del control glicémico y los lípidos son causas principales de enfermedad cardiovascular. Sin embargo, los patrones metabólicos en el infarto agudo de miocardio no están bien establecidos. Objetivo: el propósito de esta investigación es describir las características metabólicas en pacientes admitidos con infarto de miocardio. Clasificamos los pacientes según el cociente HDL-c/LDL-c y perfiles lipídicos. Método: estudio observacional, descriptivo, retrospectivo en pacientes admitidos al Servicio de Cardiología con infarto agudo de miocardio durante un año. Resultados: 97 pacientes fueron incluidos, predominó el sexo masculino (67%) y el promedio de edad fue 59 años (SD, ±9.9). Las características metabólicas fueron las siguientes: mediana de hemoglobina glicosilada 6.2% (IQR, 5.8-7.5), glucemia en ayunas 107 mg/dL (IQR, 99-152), colesterol total 201 mg/dL (IQR, 165-223), colesterol asociado a lipoproteínas de baja densidad (LDL-c) 123 mg/dL (IQR, 96-146), colesterol asociado a lipoproteínas de alta densidad (HDL-c) 38.2 mg/dL (IQR, 31.8-45.4) y triglicéridos (TG) 161 mg/dL (IQR, 103-234). El cociente HDL-c/LDL-c <0.4 estuvo presente en 75% de los pacientes. Los patientes fueron clasificados según perfiles lipídicos, donde el perfil L-1 [HDL-c ≤40, LDL-c <150, TG <200] y L-2 [HDL-c >40, LDL-c <150, TG <200] en conjunto representaron la mitad de la muestra. Conclusiones: prediabetes, bajos niveles de HDL-c y un cociente HDL-c/LDL-c <0.4 fueron hallazgos frecuentes en infarto de miocardio. La relación entre patrones metabólicos y el riesgo de infarto de miocardio debe ser investigada. (provisto por Infomedic International)

Introduction: Alterations in glycemic control and lipids are the main causes of cardiovascular disease. However, metabolic patterns in acute myocardial infarction are not well established. Objective: The purpose of this research is to describe the metabolic characteristics of patients admitted with myocardial infarction. We classified patients according to HDL-c/LDL-c ratio and lipid profiles. Method: observational, descriptive, retrospective study in patients admitted to the Cardiology Department with acute myocardial infarction for one year. Results: 97 patients were included, males predominated (67%) and the mean age was 59 years (SD, ±9.9). Metabolic characteristics were as follows: median glycosylated hemoglobin 6.2% (IQR, 5.8-7.5), fasting blood glucose 107 mg/dL (IQR, 99-152), total cholesterol 201 mg/dL (IQR, 165-223), low-density lipoprotein cholesterol (LDL-c) 123 mg/dL (IQR, 96-146), high-density lipoprotein-associated cholesterol (HDL-c) 38.2 mg/dL (IQR, 31.8-45.4) and triglycerides (TG) 161 mg/dL (IQR, 103-234). The HDL-c/LDL-c ratio <0.4 was present in 75% of patients. Patients were classified according to lipid profiles, where the L-1 HDL-c ≤ 40, LDL-c <150, TG <200] and L-2 ]HDL-c >40, LDL-c <150, TG <200] together represented half of the sample. Conclusions: prediabetes, low HDL-c levels, and an HDL-c/LDL-c ratio <0.4 were frequent findings in myocardial infarction. The relationship between metabolic patterns and the risk of myocardial infarction should be investigated. (provided by Infomedic International)

Dislipidemia y riesgo cardiovascular en pacientes con enfermedad renal crónica / Dyslipidemia and cardiovascular risk in patients with chronic kidney disease / Dislipidemia e risco cardiovascular em pacientes com doença renal crônica

Las enfermedades cardiovasculares (Cv), son las causantes de la mayor parte de fallecimientos, como consecuencia de dislipidemia y enfermedad renal crónica (ERC). En Ecuador uno de cada cinco individuos padece de hipertensión arterial, patología que está directamente relacionada con las enfermedades cardiovasculares y la enfermedad renal crónica. Objetivo. Caracterizar el perfil de riesgo cardiovascular en pacientes con enfermedad renal crónica y su asociación con la presencia de dislipidemia, atendidos en el Hospital Homero Castanier de la ciudad de Azogues, durante el periodo de enero a diciembre de 2021. Materiales y Métodos. Se llevó a cabo una investigación de diseño observacional, descriptivo y retrospectivo donde se analizaron 104 historias clínicas de pacientes, correspondientes al periodo comprendido entre enero y diciembre de 2021. Para el cálculo del riesgo cardiovascular se empleó la tabla de predicción del riesgo AMR-D de la Organización Mundial de la Salud/Sociedad Internacional de Hipertensión para el continente americano categoría D. Los datos fueron analizados en el programa SPSS, mediante estadística descriptiva e inferencial. Resultados. De los datos analizados de los 104 pacientes con enfermedad renal crónica el 44,2% presentaron dislipidemia, al mismo tiempo el 74% de los pacientes en estudio manifestaron un riesgo cardiovascular bajo, seguido del 13,5% con riesgo moderado; destacando entre las principales comorbilidades la hipertensión arterial y la diabetes mellitus. Conclusiones. Se caracterizó el riesgo cardiovascular de los pacientes con ERC atendidos en el Hospital Homero Castanier de la ciudad de Azogues en el periodo enero - diciembre 2021, encontrando una baja prevalencia de desarrollar riesgo cardiovascular.

Cardiovascular diseases (CVD) are responsible for most deaths as a consequence of dyslipidemia and chronic kidney disease (CKD). In Ecuador, one out of every five individuals suffers from arterial hypertension, a pathology that is directly related to cardiovascular diseases and chronic kidney disease. Objective. To characterize the cardiovascular risk profile in patients with chronic kidney disease and its association with the presence of dyslipidemia, attended at the Homero Castanier Hospital in the city of Azogues, during the period from January to December 2021. Materials and Methods. An observational, descriptive and retrospective research design was carried out in which 104 clinical histories of patients were analyzed, corresponding to the period between January and December 2021. The AMR-D risk prediction table of the World Health Organization/International Society of Hypertension for the Americas category D was used to calculate cardiovascular risk. The data were analyzed in the SPSS program, using descriptive and inferential statistics. Results. Of the data analyzed, 44.2% of the 104 patients with chronic kidney disease presented dyslipidemia; at the same time, 74% of the patients in the study showed low cardiovascular risk, followed by 13.5% with moderate risk, with arterial hypertension and diabetes mellitus standing out among the main comorbidities. Conclusions. The cardiovascular risk of patients with CKD treated at the Homero Castanier Hospital in the city of Azogues during the period January-December 2021 was characterized, finding a low prevalence of developing cardiovascular risk.

As doenças cardiovasculares (DCV) são responsáveis pela maioria das mortes como consequência da dislipidemia e da doença renal crônica (DRC). No Equador, um em cada cinco indivíduos sofre de hipertensão arterial, uma patologia que está diretamente relacionada às doenças cardiovasculares e à doença renal crônica. Objetivo. Caracterizar o perfil de risco cardiovascular em pacientes com doença renal crônica e sua associação com a presença de dislipidemia, atendidos no Hospital Homero Castanier, na cidade de Azogues, durante o período de janeiro a dezembro de 2021. Materiais e métodos. Foi realizado um desenho de pesquisa observacional, descritivo e retrospectivo, no qual foram analisados 104 históricos clínicos de pacientes, correspondentes ao período entre janeiro e dezembro de 2021. A tabela de previsão de risco AMR-D da Organização Mundial da Saúde/Sociedade Internacional de Hipertensão para as Américas categoria D foi usada para calcular o risco cardiovascular. Os dados foram analisados no SPSS usando estatísticas descritivas e inferenciais. Resultados. Dos 104 pacientes com doença renal crônica, 44,2% apresentavam dislipidemia, enquanto 74% dos pacientes em estudo tinham baixo risco cardiovascular, seguidos por 13,5% com risco moderado; as principais comorbidades foram hipertensão e diabetes mellitus. Conclusões. Foi caracterizado o risco cardiovascular dos pacientes com DRC atendidos no Hospital Homero Castanier da cidade de Azogues no período de janeiro a dezembro de 2021, encontrando uma baixa prevalência de desenvolvimento de risco cardiovascular.

Frecuencia de síndrome metabólico en adultos mayores de la ciudad El Alto-Bolivia, gestión 2019 / Frequency of metabolic syndrome among elderly people in the city of El Alto, Bolivia, in 2019

INTRODUCCIÓN: el síndrome metabólico es una entidad compleja, compuesta por factores de riesgo cardiaco como: Obesidad, Diabetes. Hipertensión, dislipemia etc. OBJETIVO: determinar la frecuencia de síndrome metabólico en adultos mayores de la ciudad El Alto, durante la gestión 2019. METODOLOGÍA: investigación transversal cuantitativa, se evaluaron a 124 individuos, reclutados en Auki Utas por el gobierno autónomo municipal de El Alto, mediante coordinación con la Unidad de Protección al Adulto Mayor, durante la gestión 2019. Previo consentimiento informado, se determinó antropometría, tensión arterial, toma de muestra de sangre venosa, para procesamiento de pruebas bioquímicas, (glucemia, triglicéridos, colesterol total, HDL colesterol y LDL colesterol). RESULTADOS: el 62% (77/124) de la población estudiada se encuadra dentro del diagnóstico de síndrome metabólico, presentando datos alterados en por lo menos tres de los criterios evaluados. CONCLUSIONES: la población estudiada presenta altos porcentajes de síndrome metabólico, con mayor tendencia a la obesidad e hipertensión, por lo que es importante la promoción y prevención, ya que el sobrepeso y obesidad son factores de riesgo para la resistencia a la insulina, determinante de los demás criterios (marcadores), actividades de promoción y prevención son necesarias en la ciudad de El Alto, para evitar morbimortalidad por síndrome metabólico

INTRODUCTION: metabolic syndrome is a complex entity, composed of cardiac risk factors such as: obesity, diabetes. hypertension, dyslipidemia, etc. OBJECTIVE: determine a baseline regarding metabolic syndrome in older adults in the El Alto city, which can be used in the future to carry out potential preventive interventions. METHODOLOGY: quali-quantitative research, studied 124 individuals, recruited in Auki Utas by the Autonomous Municipal Government of El Alto city, through coordination with the Protection Unit for the Elderly, during the 2019 administration. Prior informed consent, anthropometry was determined blood pressure, venous blood sampling, for processing biochemical tests (blood glucose, triglycerides, cholesterol, HDL and LDL). RESULTS: 62% (77/124) of the studied population falls within the diagnosis of metabolic syndrome, presenting altered data in at least three of the evaluated entities. CONCLUSIONS: the population studied presents high percentages of metabolic syndrome, with a greater tendency to obesity and hypertension, so promotion and prevention is important, since overweight and obesity are risk factors for insulin resistance, a determinant of the other criteria (markers), promotion and prevention activities are necessary in the El Alto city, to avoid morbidity and mortality due to metabolic syndrome

La actividad física como reductora de riesgo cardiovascular en personas hipertensas

Hoy día la hipertensión arterial es una enfermedad que afecta aproximadamente a la tercera parte de la población adulta a nivel mundial. Esta patología, a su vez, es el primer factor de riesgo cardiovascular, pero también un factor de riesgo de enfermedad renal crónica y demencia. Las enfermedades cardiovasculares constituyen la primera causa de muerte a nivel mundial, regional, nacional y provincial, por lo que son de vital importancia las acciones encaminadas al manejo, control y reducción del riesgo a desarrollarlas. La práctica saludable de ejercicio físico es una herramienta económica y efectiva como coadyuvante del tratamiento de la hipertensión arterial y reductora de riesgo cardiovascular. Tanto los ejercicios aeróbicos como anaeróbicos tienen efectos positivos sobre las cifras de presión arterial, ayudan a controlar los niveles de colesterol en sangre, y son efectivos contra la dislipidemia e incluso contra la diabetes mellitus, patologías que elevan aún más el riesgo cardiovascular. La actividad física saludable también combate el sedentarismo y regula el peso corporal. Sin embargo, el estado de actividad física no se tiene en cuenta directamente a la hora de estratificar el riesgo cardiovascular en los predictores usados actualmente en el país, que son los propuestos por la Organización Panamericana de la Salud. De ahí que este trabajo tenga como objetivo fundamentar el papel de la práctica de actividad física como reductora de riesgo cardiovascular en personas hipertensas.

Today, arterial hypertension is a disease that affects almost one third of the adult population worldwide. This disease, in turn, is the first cardiovascular risk factor, but also a risk factor for chronic renal disease and dementia. Cardiovascular diseases are the leading cause of dead at the global, regional, national and provincial levels, so actions aimed at managing, controlling and reducing the risk of developing them are of vital importance. The healthy practice of physical exercise is an effective and economic tool as an adjuvant to the treatment of arterial hypertension and reductor of cardiovascular risk. Both aerobic and anaerobic exercises have positive effects on blood pressure levels, help control blood cholesterol levels and are effective against dyslipidemia and even against diabetes mellitus, pathologies that further increase cardiovascular risk. Healthy physical activity also fights sedentary lifestyle and regulates body weight. However, the physical activity status is not directly taken into account when stratifying cardiovascular risk in the predictors currently used in the country that are those proposed by the Pan American Health Organization. That is why this work aims to substantiate the role of the practice of physical activity as cardiovascular risk reductor in hypertensive persons.

Impacto de la optimización del tratamiento hipolipemiante en el riesgo cardiovascular residual / Impact of Optimizing Lipid-Lowering Therapy on Residual Cardiovascular Risk

RESUMEN Introducción: el modelo SMART-REACH predice el riesgo de eventos cardiovasculares recurrentes. Objetivos: los objetivos de este estudio fueron: a) evaluar el riesgo residual en una población en prevención secundaria y niveles de colesterol asociado a lipoproteínas de baja densidad (C-LDL) fuera de meta; b) mediante un modelo de simulación, determinar el impacto de optimizar las terapias hipolipemiantes en términos de reducción del riesgo residual. Material y métodos: estudio transversal, descriptivo y multicéntrico. Se incluyeron consecutivamente pacientes con antecedentes cardiovasculares y un C-LDL mayor o igual que 55 mg/dL. El riesgo de eventos recurrentes (infarto agudo de miocardio, accidente cerebrovascular o muerte vascular) a 10 años y a lo largo de la vida se estimó utilizando el modelo SMART-REACH. Mediante una simulación, se optimizó el tratamiento hipolipemiante de cada paciente (utilizando estatinas, ezetimibe o inhibidores de proproteína convertasa subtilisina kexina tipo 9 [iPCSK9]), se estimó el descenso del C-LDL, se verificó el alcance del objetivo lipídico y se calculó la reducción del riesgo cardiovascular y el número necesario a tratar (NNT) correspondiente. Resultados: se incluyeron 187 pacientes (edad media 67,9 ± 9,3 años, 72,7% hombres). Los riesgos residuales calculados a 10 años y a lo largo de la vida fueron 37,1 ± 14,7% y 60,3 ± 10,7%, respectivamente. Globalmente, se pudo optimizar una sola estrategia farmacológica con estatinas, ezetimibe o un iPCSK9 en el 38,5%, el 11,5% y el 5,5% de la población, respectivamente. La optimización basada en dos tratamientos se realizó en el 27,5% (estatinas + ezetimibe), el 7,7% (estatinas + iPCSK9) y el 1,1% (ezetimibe + iPCSK9) de los casos. En 15 pacientes se optimizó el tratamiento considerando los tres fármacos. El 53,9% y el 62,9% de las acciones para optimizar el tratamiento mostraron un NNT menor que 30 para evitar un evento a 10 años o a lo largo de la vida, respectivamente. Conclusión: en este estudio, los pacientes con antecedentes cardiovasculares que no alcanzan la meta de C-LDL mostraron un riesgo residual considerable. La simulación mostró un importante margen para optimizar el tratamiento, con un impacto notable en el riesgo residual.

ABSTRACT Background: The SMART-REACH model predicts the risk or recurrent cardiovascular events. Objectives: The objectives of this study were: a) to evaluate the residual cardiovascular risk in a secondary prevention population with LDL-C levels above the recommended goal, using a simulation model; and b) to determine the impact of optimizing lipid-lowering therapies in terms of residual cardiovascular risk reduction. Methods: We conducted a cross-sectional, descriptive and multicenter study. Patient with a history of cardiovascular disease and a LDL-C ≥55 mg/dL were consecutively included. The 10-year and lifetime risk of recurrent events (myocardial infarction, stroke, or vascular death) were estimated using the SMART-REACH model. By means of a simulation, lipid-lowering treatment was optimized for each patient [using statins, ezetimibe and/or PCSK9 (PCSK9) inhibitors], with estimation of LDL-C reduction, checking if lipid-lowering goal was achieved and calculating the reduction in cardiovascular risk and the corresponding number needed to treat (NNT). Results: The cohort was made up of 187 patients; mean age was 67.9 ± 9.3 years and 72.7% were men. The calculated 10-year and lifetime residual risks were 37.1 ± 14.7% and 60.3 ± 10.7%, respectively. Overall, treatment was optimized with a single pharmacological strategy with statins, ezetimibe or PCSK9 inhibitor in 38.5%, 11.5% and 5.5% of the population, respectively. Optimization based on two treatments was performed in 27.5% (statins + ezetimibe), 7.7% (statins + PCSK9 inhibitor) and 1.1% (ezetimibe + PCSK9 inhibitor) of the cases. In 15 patients, treatment was optimized when the three drugs (statins + ezetimibe + PCSK9 inhibitor) were considered. Overall, 53.9% and 62.9% of the actions implemented to optimize treatment showed a 10-year or lifetime NNT < 30 to prevent an event, respectively. Conclusion: In this study, patients with a history of cardiovascular disease who do not reach LDL-C goal showed significant residual cardiovascular risk. The simulation model showed a significant margin for optimizing treatment, with a marked reduction in residual cardiovascular risk.

El endotelio sano y su disfunción en el riesgo cardiovascular / Healthy Endothelium and its Dysfunction in Cardiovascular Risk

Resumen El endotelio es una monocapa formada por células aplanadas llamadas w, que revisten la parte más interna del corazón, los vasos sanguíneos y los linfáticos. Es considerado un órgano que tiene una función de barrera, pero además se encarga de regular la permeabilidad y tono vascular, hemostasia, inflamación y angiogénesis. Esta revisión se centra sobre todo en las generalidades del endotelio vascular sano y su disfunción. Se analizan los conceptos de activación y disfunción, en donde la activación se considera como un proceso autolimitado, indispensable para la hemostasia y la inflamación. La disfunción endotelial, en cambio, es un proceso patológico, de mayor duración y que se presenta cuando el endotelio ya no puede autorregularse y cambia a un fenotipo proinflamatorio y protrombótico permanente. Esta disfunción es el primer cambio que lleva a la ateroesclerosis y al aumento del riesgo cardiovascular, por esta razón se revisan los principales biomarcadores de disfunción endotelial y riesgo cardiovascular. A medida que se avance en el conocimiento básico del endotelio y su disfunción, será posible diseñar nuevas medidas preventivas o terapéuticas que puedan disminuir dicho riesgo.

Abstract The endothelium is a monolayer of flatten cells named endothelial cells that form the inner layer of the heart, blood, and lymphatic vessels. Its function is not just as a barrier, but it is a regulator of vascular permeability and tone, hemostasis, inflammation, and angiogenesis. This review is about the general aspects of vascular endothelium and endothelial dysfunction that leads to increased vascular risk. Activation and dysfunction are discussed, considering the endothelial activation as a self-limiting process, necessary to promote inflammation and hemostasis. Endothelial dysfunction is a pathological process in which the endothelium loses its ability for self-regulation and acquires a prothrombotic and proinflammation phenotype. Endothelial dysfunction is the initial step for atherosclerosis and increased cardiovascular risk, so the main biomarkers of endothelial dysfunction are reviewed. As basic knowledge about endothelium increases, preventive or therapeutic measures can be designed as treatment or prevention the risk of its dysfunction.

Recomendaciones de terapia Antihipertensiva: la importancia de las combinaciones Avalado por la Sociedad Centroamericana y del Caribe de Cardiología / Antihypertensive therapy recommendations: the importance of combinations Endorsed by the Central American and Caribbean Society of Cardiology

RESUMEN El presente trabajo es el resultado de una iniciativa para analizar, resumir y mostrar la evidencia científica más reciente sobre el tema de la hipertensión y la implementación de las mejores terapéuticas disponibles. Este documento fue creado con la colaboración conjunta de médicos especialistas para dar una perspectiva local a la gestión basada en la mejor evi- dencia científica y en el contexto de la región de Centroamérica y el Caribe. Este artículo cuenta con el respaldo científico y académico de la Sociedad Centroamericana y del Caribe de Cardiología y es el primero de su tipo en abordar el problema y tema de la hipertensión. Se desarrolló a partir de una revisión detallada de la evidencia científica utilizando los principales buscadores médicos, seleccionando los estudios pivotales y poblacionales con mayor nivel de evidencia disponible. La in- tención es brindar información sencilla, con recomendaciones fáciles de implementar en el manejo diario de los pacientes con hipertensión arterial. Este documento contó con el apoyo logístico del Laboratorio Servier, tanto con los autores como en su edición; sin embargo, la información clínica presentada no estuvo condicionada por el laboratorio. Este material es responsabilidad de los autores.

ABSTRACT Antihypertensive therapy recommendations: the importance of combinations Endorsed by the Central American and Caribbean Society of Cardiology The present work is the result of an initiative to analyze, summarize, and show the latest scientific evidence on the subject of hypertension and the implementation of the best available therapeutics. This document was created with the joint collaboration of medical specialists to give a local perspective to the management based on the best scientific evidence and in the context of the Central American and Caribbean region. This paper has the scientific and academic support of the Central American and Caribbean Society of Cardiology and is the first of its kind to address the problem and topic of hypertension. It was developed from a detailed review of the scientific evidence using the main medical search engines, selecting the pivotal and population-based studies with the highest level of evidence available. The intention is to provide simple information, with easy-to-implement recommendations to implement in the daily management of patients with arterial hypertension. This document had the logistic support of Servier Laboratory, both with the authors as well as its editing; however, the clinical information presented was not conditioned by the laboratory. This material is the responsibility of the authors.

[Lower urinary tract symptoms in patients with arterial hypertension. Cardiovascular risk and impact on their quality of life]. / Síntomas del tracto urinario inferior en pacientes con hipertensión arterial. Riesgo cardiovascular e impacto en su calidad de vida.

OBJETIVES: To determine the prevalence of erectile lower urinary tract symptoms in hypertensive patients, cardiovascular risk and the impact on quality of life. MATERIAL AND METHODS: Setting: Health Center (Vilagarcia, Pontevedra). PERIOD: April 2015-June 2017. INCLUSION CRITERIA: Hypertensive patient with informed consent. MEASUREMENTS: sociodemographic variables, toxic habits, comorbidity, blood pressure, cardiovascular risk, analytical and examination parameters. Questionaries: International Prostate Symptom Scale (IPSS), International Index of Erectile Function (IIEF-15) and quality of life in arterial hypertension (MINICHAL). SAMPLE SIZE: n=262 (± 6% accuracy, 95% confidence). STATISTICAL ANALYSIS: Bivariate and multivariate statistical analysis. Informed consent and ethics committee approval were obtained (2024/237) RESULTS: The mean age was 65.84 (12.70), and mean hypertension duration of 13.25 (9.84) years. 76.7% reported lower tract urinary symptoms, 91.6% being mild. The bivariate analysis showed an association with the variables: age, educational level, profession, work activity, tobacco, benign prostatic hypertrophy, years of diagnosis, concomitant medication, Framingham-Wilson score, electrocardiogram, glycated hemoglobin, glomerular filtration (Crockroft-Gault), LDL-cholesterol, somatic manifestations (MINICHAL), erectile dysfunction. The multivariate analysis showed increased risk with:abdominal obesity, pathological electrocardiogram, high risk of Framingham-Wilson score, erectile dysfunction, use of hypouricemics agents and decreased with not smoking and use diuretics. CONCLUSIONS: Three quarters of hypertensive men presented lower urinary tract symptoms, increasing the risk of cardiovascular disease early according to the Framingham-Wilson score. Other predictive factors were: abdominal obesity, tobacco, pathological electrocardiogram, high Framingham-Wilson score, erectile dysfunction, use of hypouricemics agents.

Marcadores lipídicos en los pacientes con VIH/sida en tratamiento con inhibidores de la proteasa

Introducción: Las enfermedades cardiovasculares constituyen la principal causa de morbimortalidad a escala mundial. Otra enfermedad con impacto significativo en los sistemas de salud pública es el VIH/sida. Los pacientes infectados con el virus de la inmunodeficiencia humana, tienen mayor riesgo de desarrollar enfermedades cardiovasculares. Posterior al tratamiento antirretroviral ha disminuido la incidencia de enfermedades oportunistas asociadas al VIH/sida, y se ha elevado la incidencia de enfermedades asociadas al envejecimiento, como la enfermedad cardiovascular. El uso de antirretrovirales inhibidores de la proteasa se asocia a hiperlipidemia y, por consiguiente, al aumento de complicaciones cardiovasculares. Objetivo: Determinar los marcadores lipídicos en pacientes con VIH/sida en tratamiento con inhibidores de la proteasa. Materiales y métodos: Se realizó un estudio observacional, analítico, transversal en los pacientes con VIH/sida de la provincia de Matanzas, durante el período comprendido entre marzo y agosto de 2020, en el Laboratorio Clínico del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández. Resultados: Se evaluaron los marcadores lipídicos como factor de riesgo cardiovascular asociado al tratamiento antirretroviral, siendo los triglicéridos el de mayor incidencia. Conclusiones: Se identificaron los marcadores lipídicos como factores de riesgo cardiovascular, en este caso la hipertrigliceridemia.

Introduction: Cardiovascular diseases are the main risk of morbidity and mortality worldwide. Another disease with significant impact on public health systems is HIV/AIDS. Patients infected with the human immunodeficiency virus have a higher risk of developing cardiovascular diseases. After antiretroviral treatment, the incidence of opportunistic diseases associated with HIV/AIDS has decreased and the incidence of diseases associated with aging such as cardiovascular disease has increased. The use of protease inhibitor antiretroviral drugs is associated with hyperlipidemia and a consequent increase in cardiovascular complications. Objective: To determine lipid markers in patients with HIV/AIDS undergoing treatment with protease inhibitors. Materials and method: An observational, analytical, cross-sectional study was carried out in patients with HIV/AIDS from the province of Matanzas during the period from March to August 2020, in the Clinical Laboratory of the Provincial Teaching Clinical Surgical Hospital Faustino Pérez Hernandez. Results: Lipid markers were evaluated as cardiovascular risk factor associated with antiretroviral treatment, with triglycerides being the one of highest incidence. Conclusions: Lipid markers were identified as cardiovascular risk factors; in this case hypertriglyceridemia.

Factores de riesgos de mortalidad por enfermedades cardiovasculares en adultos mayores / Mortality Risk Factors from Cardiovascular Diseases in Older Adults

Introducción: Las enfermedades cardiovasculares ateroescleróticas están en el nivel máximo de las enfermedades que afectan tanto a mujeres como a hombres adultos mayores en todo el mundo. Objetivo: Evaluar las posibles diferencias de sexo y tipo de enfermedad aterosclerótica, en pacientes mayores de 60 años, fallecidos por enfermedad cardiovascular. Métodos: Se realizó un estudio descriptivo de corte transversal en 237 adultos mayores, fallecidos por enfermedad cardiovascular, perteneciente a tres áreas de salud del municipio Santiago de Cuba, en el período de enero a diciembre de 2021 Se analizaron variables socio-demográficas y clínicas. La información fue procesada y analizada mediante estadística descriptiva. Se sistematizó la información con el paquete estadístico versión 22 y Excel. Resultados: Existieron diferencias significativas en los factores de riesgos de tabaquismo y alcoholismo con una mayor frecuencia en la población masculina, la obesidad, el sedentarismo y la diabetes mellitus fue más relevante en las mujeres, con similar comportamiento en el infarto agudo de miocardio y la enfermedad cerebrovascular. Conclusiones: La mortalidad generada por las enfermedades cardiovasculares, en la población de adultos mayores, es similar para ambos sexos la presencia de factores de riesgo evidenciaron la misma frecuencia para la mortalidad por enfermedad del corazón y cerebrovascular(AU)

Introduction: Atherosclerotic cardiovascular diseases are at the highest level of diseases that affect both older women and men worldwide. Objective: To evaluate the possible differences of sex and type of atherosclerotic disease in patients over 60 years of age who died of cardiovascular disease. Methods: A descriptive cross-sectional study was carried out in 237 older adults who died from cardiovascular disease, belonging to three health areas of Santiago de Cuba municipality, from January to December 2021. Sociodemographic and clinical variables were analyzed. The information was processed and analyzed using descriptive statistics. The information was systematized with the statistical package version 22 and Excel. Results: There were significant differences in the risk factors of smoking and alcoholism with a higher frequency in the male population, obesity, sedentary lifestyle. Diabetes mellitus was more relevant in females, with similar behavior for acute myocardial infarction and cerebrovascular disease. Conclusions: The mortality generated by cardiovascular diseases, in the population of older adults, is similar in both sexes. The presence of risk factors showed the same frequency for mortality from heart disease and cerebrovascular disease(AU)