Logro de metas de prevención secundaria, prescripción farmacológica y eventos cardiovasculares mayores en pacientes con enfermedad coronaria / Achievement of cardiovascular prevention goals, pharmacologic prescription and major cardiovascular events among patients with coronary disease

Background: Implementation of health programs to reduce cardiovascular risk, are needed for secondary prevention of cardiovascular diseases. Aim: To evalúate achievements of secondary prevention goals, pharmacologic prescription and major cardiovascular events in patients with coronary artery disease. Material and Methods: Patients who had a first event of acute coronary syndrome, angioplasty or revascularization surgery, between January 2008 and June 2010, were contacted for a clinical and laboratory evaluation between June and October 2011. Results: Seven hundred and two medical records were reviewed and 245 eligible patients were identified. Ofthese, we assessed 202 patients aged 64 ± 10 years (70% males). Sixty seven percent had two ormore cardiovascular riskfactors. A goal ofHDL cholesterol level over 40 mg/dL was achieved in 91 % of patients, smoking cessation in 84% and a total cholesterol < 200 mg/dL in 66%. A blood pressure below 130/85 mm Hgwas achieved in 30% of patients, a normal BMI in 19% and LDL cholesterol levels below 70 mg/dL in 18%. At the moment of assessment, 87%> were using aspirin, 78%> statins, 74% angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists and 66%o were using β - blockers. Twenty two percent of patients had a major cardiovascular event during the follow up, which lasted 28 ± 8 months. Conclusions: A low percentage of cardiovascular goals achievement was observed in this sample of patients, with a high prevalence of overweight and obesity. A high percentage quit smoking after their first cardiovascular event. Despite the high percentage of drug prescription, hypertension and dyslipidemia were not fully controlled.

Evaluación de una maniobra nutricional tendiente a reducir los niveles de colesterol en pacientes portadores de enfermedad coronaria en el sistema público de salud chileno / Evaluation of a nutritional intervention to reduce cholesterol levels in patients with coronary artery disease

Background: The mainstay of cholesterol reduction therapy is the diet. But the lack of compliance and prescription problems limit its usefulness. Aim: To compare the effectiveness of a nutritional intervention given by a nutritionist with the usual recommendations given by a physician to reduce the LDL cholesterol levels in patients with coronary artery disease, treated at the Regional public hospital in Temuco. Material and Methods: One hundred and forty patients with coronary heart disease (last acute episode at least three months before), without nutritional interventions nor cholesterol-lowering drugs, who gave informed consent, were randomized to receive either instructions by their physician or to take part in a nutritional program. The nutritional intervention consisted in five educational sessions, adapted from the NCEP and from a program of the Nutrition Department of the Catholic University of Chile. Patients randomized to the medical intervention received the standard written recommendations about diet. Lipid profile was measured before the intervention and after a three and twelve months follow up. Results: After one year the group on the nutritional program reduced LDL cholesterol by 11.1% (p=0.03). There were no changes in the medical group. However, only 10% patients on the nutritional intervention group and 8% of those with medical recommendations achieved LDL cholesterol levels less than 100 mg/dl. There were no changes in triglycerides, weight or body mass index during the period. Conclusions: Although this nutritional intervention proved to be more effective than usual medical instructions, most patients on secondary prevention did not achieve acceptable LDL cholesterol levels (Rev Méd Chile 2004; 132: 1457-65).

Resultados del primer registro chileno de angina inestable: características clínicas, perfil de riesgo y tratamiento / Results of the first Chilean registry of unstable angina: clinical features, risk profile and treatment

Background: From January 2000 to June 2002, the first Chilean registry of unstable angina was carried out, with the participation of 15 hospitals. Aim: To report the clinical and demographic features of 600 patients with unstable angina, their risk profile and prognosis. Material and methods: The inclusion criteria for this prospective registry were a history of recent onset of chest pain (<48 hours) or a change in the character of previous angina, associated to ischemic electrocardiographic changes and/or positive markers of myocardial damage. Results: Mean age of the patients was 65 years and 37 percent were women. Among coronary risk factors, 63 percent had hypertension, 27percent had diabetes, 52percent had dyslipidemia, 31percent smoked and 21percent had a family history of atherosclerosis. On admission 94percent of patients had chest pain, associated to ST segment depression in 44 percent, negative T waves in 28 percent and positive markers of myocardial damage in 30percent. Fifty seven percent received intravenous nitroglycerin, 47 percent received oral nitrates, 69 percent beta blockers and 15 percent, calcium antagonists. Antithrombotic therapy included aspirin in 96 percent, heparin in 74percent, ticlodipine or clopidogrel in 19 percent and IIb/IIIa inhibitors in 12percent. A coronary angiogram was performed in 52percent, angioplasty in 25percent and coronary bypass surgery in 13percent. Hospital mortality was 2.6percent. The incidence of new ischemic events was: myocardial infarction in 2.8percent recurrent ischemia in 9.5percent and refractory ischemia in 2percent. The incidence of adverse events increased according to a higher risk profile. Conclusions: The demographic and clinical features, treatment and mortality of these patients are similar to those reported in international registries, with a low mortality rate.

Persistencia de factores de riesgo coronario en pacientes diabéticos sometidos a cirugía de revascularización miocárdica / Persistence of coronary risk factors in diabetic patients submitted to myocardial revascularization

Se estudia la persistencia de factores de riesgo coronario en un grupo de 45 pacientes diabéticos tipo 2 operados de cirugía de revascularización miocárdica (CRVM)en el Hospital Regional de Temuco. Se mide: índice masa corporal, presión arterial, perfil lipídico, glicemia y tabaquismo antes y después de CRVM,Con seguimiento promedio de 44,9 meses se encuentra que, excepto el tabaquismo, ningún factor disminuye en el postoperatorio. este hallazgo debería llevar a la adopción de políticas de salud tendientes a prevenir y/o tratar estos factores deletéreos, para así mejorar los resultados a mediano y largo plazo de una cirugía de alto costo y riesgosa como la cirugía de revascularización miocardica

La digoxina es efectiva en el tratamiento de pacientes con insuficiencia cardíaca y ritmo sinusal / Digoxin is effectiveness in the treatment of cardiac failure and sinus rhythm patients

Due to differences in treatment effect in studies on the effectiveness of digoxin in patients with congestive heart failure in sinus rhythm, a cross-over placebo-controlled randomized double blind clinical trial was performed. Thirty one patients, without previous treatment with digoxin, in New York Heart Association (NYHA) functional class II to IV, with a dilated left ventricle and/or ventricular systolic dysfunction were included. Patients received digoxin, adjusted for blood levels, or placebo, during an 8 week period, prior to crossing over to the other treatment for another 8 weeks. The order of tretments was randomly allocated. Outcome measurement were performed at the end of each 8 week period. Digoxin, compared with placebo, improved NYHA class, 6,9 por ciento vs 41.4 por ciento (p=0.013) and increased the treadmill exercise time, 406 ñ 204 s vs 484 ñ 185 s (p=0.003). During the digoxin treatment the left ventricular and systolic diameter was reduced from 52.9 ñ 8.9 to 50.1 ñ 9.7 mm (p=0.009). No significant difference was observed in the left ventricular end diastolic diameter (LVED) of the left ventricle and in a estimation of quality of life. In conclusion, digoxin treatment produced a significant improvement in functional capacity, exercise time and left ventricular performance