Predictors of the response to phosphodiesterase-5 inhibitors in pulmonary arterial hypertension: an analysis of the Spanish registry.

BACKGROUND: Achieving and maintaining a low-risk profile is associated with favorable outcome in pulmonary arterial hypertension (PAH). The effects of treatment on risk profile are variable among patients. OBJECTIVE: To Identify variables that might predict the response to treatment with phosphodiesterase-5 inhibitors (PDE-5i) in PAH. METHODS: We carried out a cohort analysis of the Spanish PAH registry in 830 patients diagnosed with PAH that started PDE5i treatment and had > 1 year follow-up. 644 patients started PDE-5i either in mono- or add-on therapy and 186 started combined treatment with PDE-5i and endothelin receptor antagonist (ERA). Responders were considered when at 1 year they: (1) were alive; (2) did not present clinical worsening; and (3) improved European Society of Cardiology/European Respiratory Society (ESC/ERS) risk score or remained in low-risk. Univariate and multivariate logistic regression models were used to analyze variables associated with a favorable response. RESULTS: Two hundred and ten patients (33%) starting PDE-5i alone were classified as responders, irrespective of whether it was mono- or add-on therapy. In addition to known predictors of PAH outcome (low-risk at baseline, younger age), male sex and diagnosis of portopulmonary hypertension (PoPH) or HIV-PAH were independent predictors of favorable response to PDE-5i. Diffusing capacity for carbon monoxide (DLco) ≤ 40% of predicted was associated with an unfavorable response. When PDE-5i were used in upfront combination, 58% of patients were responders. In this group, diagnosis of idiopathic PAH (IPAH) was an independent predictor of favorable response, whereas connective tissue disease-PAH was associated with an unfavorable response. CONCLUSION: Male sex and diagnosis of PoPH or HIV-PAH are predictors of favorable effect of PDE-5i on risk profile when used as mono- or add-on therapy. Patients with IPAH respond more favorably to PDE-5i when used in upfront combination. These results identify patient profiles that may respond favorably to PDE-5i in monotherapy and those who might benefit from alternative treatment strategies.

Circular con tasa de alcohol superior a la legal: caracterización del conductor según la vía de circulación / Driving with alcohol content above the legal limits: profile of the driver according to the type of road

Se realiza un estudio transversal de los controles policiales para la medición de la tasa de alcohol en aire espirado (AAE) llevados a cabo en Cataluña en el año 2013. La muestra consta de 464.134 pruebas, de las cuales el 66% se realizaron en vías interurbanas y el 34% en vías urbanas. Método: Se mide si el conductor sobrepasa el límite legal en miligramos de alcohol por litro de aire espirado. En el caso de conductores noveles o profesionales el límite legal es de 0,15 mg/l y para el resto de conductores es de 0,25 mg/l. Se realiza un análisis descriptivo del porcentaje de conductores detectados por encima del límite legalmente permitido en vías interurbanas y en vías urbanas, según características del conductor y del vehículo, motivo de la prueba, y momento en que se lleva a cabo. En una segunda parte, se ajustan dos modelos lineales generalizados con vínculo logarítmico y familia binomial, según si la prueba se realiza en vía interurbana o en vía urbana. Resultados: La edad del conductor, la nacionalidad o la franja horaria en la que se realiza la prueba inciden de forma diferente en la probabilidad de sobrepasar el límite legal de alcohol, dependiendo de si la prueba se realiza en vía interurbana o urbana. Conclusión: Diseñar políticas de seguridad vial específicas según el tipo de vía puede ayudar a reducir la proporción de conductores que superan los límites legales de alcohol en aire espirado y, por tanto, la accidentalidad

A cross-sectional study of the alcohol breath tests carried out by police officers in Catalonia in 2013 is performed. The sample consists of 464,134 breath tests, of which 66% were held on interurban roads and 34% on urban roads. Method: We measure whether the driver exceeds the legal limit in milligrams of alcohol per litre of exhaled air. For novice or professional drivers the legal limit is 0.15 mg/l, while for other drivers it is 0.25 mg/l. First, a descriptive analysis of the percentage of drivers detected above the legally permitted limit on interurban and urban roads is performed. It takes into account the characteristics of the driver and the vehicle, the reason for the test, and the timeframe. Afterwards, two generalized linear models with binomial family and logarithmic link are adjusted, depending on whether the test is conducted on interurban or urban roads. Results: Driver age, nationality or timeframe affect the probability of exceeding the alcohol legal limit differently, depending on whether the test is conducted on interurban or urban roads. Conclusion: Designing road safety policies adapted to the type of road can help reduce alcohol-impaired driving and therefore accident rates

Prevalence of alcohol-impaired drivers based on random breath tests in a roadside survey in Catalonia (Spain).

Sobriety checkpoints are not usually randomly located by traffic authorities. As such, information provided by non-random alcohol tests cannot be used to infer the characteristics of the general driving population. In this paper a case study is presented in which the prevalence of alcohol-impaired driving is estimated for the general population of drivers. A stratified probabilistic sample was designed to represent vehicles circulating in non-urban areas of Catalonia (Spain), a region characterized by its complex transportation network and dense traffic around the metropolis of Barcelona. Random breath alcohol concentration tests were performed during spring 2012 on 7596 drivers. The estimated prevalence of alcohol-impaired drivers was 1.29%, which is roughly a third of the rate obtained in non-random tests. Higher rates were found on weekends (1.90% on Saturdays and 4.29% on Sundays) and especially at night. The rate is higher for men (1.45%) than for women (0.64%) and it shows an increasing pattern with age. In vehicles with two occupants, the proportion of alcohol-impaired drivers is estimated at 2.62%, but when the driver was alone the rate drops to 0.84%, which might reflect the socialization of drinking habits. The results are compared with outcomes in previous surveys, showing a decreasing trend in the prevalence of alcohol-impaired drivers over time.