Outcomes of a contemporary sample of patients with atrial fibrillation taking digoxin: results from the AFBAR study.

INTRODUCTION AND OBJECTIVES: We aimed to assess and compare the effect of digoxin on clinical outcomes in patients with atrial fibrillation vs those under beta-blockers or none of these drugs. METHODS: AFBAR is a prospective registry study carried out by a team of primary care physicians (n=777 patients). Primary endpoints were survival, survival free of admission due to any cause, and survival free of admission due to cardiovascular causes. The mean follow up was 2.9 years. Four groups were analyzed: patients receiving digoxin, beta-blockers, or digoxin plus beta-blockers, and patients receiving none of these drugs. RESULTS: Overall, 212 patients (27.28%) received digoxin as the only heart control strategy, 184 received beta-blockers (23.68%), 58 (7.46%) were administered both, and 323 (41.57%) received none of these drugs. Digoxin was not associated with all-cause mortality (estimated hazard ratio=1.42; 95% confidence interval, 0.77-2.60; P=.2), admission due to any cause (estimated hazard ratio=1.03; 95% confidence interval, 0.710-1.498; P=.8), or admission due to cardiovascular causes (estimated hazard ratio=1.193; 95% confidence interval, 0.725-1.965; P=.4). No association was found between digoxin use and all-cause mortality, admission due to any cause, or admission due to cardiovascular causes in patients without heart failure. There was no interaction between digoxin use and sex in all-cause mortality or in survival free of admission due to any cause. However, an association was found between sex and admission due to cardiovascular causes. CONCLUSIONS: Digoxin was not associated with increased all-cause mortality, survival free of admission due to any cause, or admission due to cardiovascular causes, regardless of underlying heart failure.

Seguimiento clínico de una muestra contemporánea de pacientes con fibrilación auricular en tratamiento con digoxina: resultados del estudio AFBAR / Outcomes of a contemporary sample of patients with atrial fibrillation taking digoxin: results from the AFBAR study

Introducción y objetivos: Evaluar el efecto de la digoxina en los resultados clínicos de los pacientes con fibrilación auricular con y sin tratamiento con bloqueadores beta. Métodos El AFBAR es un registro prospectivo llevado a cabo por un equipo de médicos de atención primaria (n = 777 pacientes). Los objetivos principales fueron la supervivencia, la supervivencia libre de hospitalización por cualquier causa y la supervivencia libre de hospitalización por causas cardiovasculares. La media de seguimiento fue 2,9 años. Se analizaron cuatro grupos: pacientes tratados con digoxina, bloqueadores beta o digoxina más bloqueadores beta, y pacientes que no recibían ninguno de estos fármacos. Resultados En total, 212 pacientes (27,28%) recibieron digoxina como única estrategia de control de frecuencia; 184 recibieron bloqueadores beta (23,68%); 58 (7,46%), ambos fármacos y 323 (41,57%), ninguno de ellos. El tratamiento con digoxina no se asoció a la mortalidad por todas las causas (razón de riesgos estimada = 1,42; intervalo de confianza del 95%, 0,710-1,498; p = 0,2), la hospitalización por todas las causas (razón de riesgos estimada = 1,03; intervalo de confianza del 95%, 0,71-1,49; p = 0,8) ni la hospitalización por causas cardiovasculares (razón de riesgos estimada = 1,193; intervalo de confianza del 95%, 0,725-1,965; p = 0,4). No se observó asociación entre el empleo de digoxina y la mortalidad por cualquier causa, la hospitalización por cualquier causa o la hospitalización por causas cardiovasculares en los pacientes sin insuficiencia cardiaca. No hubo interacción entre el uso de digoxina y el sexo en cuanto a la mortalidad por todas las causas o la supervivencia sin hospitalización por todas las causas. Sin embargo, sí se observó una asociación entre el sexo y la hospitalización por causa cardiovascular. Conclusiones: La digoxina no se asoció a un aumento de la mortalidad por cualquier causa, la supervivencia libre de hospitalización por cualquier causa ni la supervivencia libre de hospitalización por causas cardiovasculares, con independencia de la presencia de insuficiencia cardiaca subyacente (AU)

Introduction and objectives We aimed to assess and compare the effect of digoxin on clinical outcomes in patients with atrial fibrillation vs those under beta-blockers or none of these drugs. We compared the incidence of ventricular arrhythmias in patients who were undergoing cardiac resynchronization therapy with an implantable cardioverter-defibrillator in terms of the degree of echocardiographic response to resynchronization. Patients were classified in 3 subgroups; super-responders, responders, and nonresponders. Methods AFBAR is a prospective registry study carried out by a team of primary care physicians (n = 777 patients). Primary endpoints were survival, survival free of admission due to any cause, and survival free of admission due to cardiovascular causes. The mean follow up was 2.9 years. Four groups were analyzed: patients receiving digoxin, beta-blockers, or digoxin plus beta-blockers, and patients receiving none of these drugs. Conclusions Digox in was not associated with increased all-cause mortality, survival free of admission due to any cause, or admission due to cardiovascular causes, regardless of underlying heart failure(AU)

[Effect of the location of previous atherosclerotic disease on prognosis in diabetic patients. The Barbanza Diabetes Study]. / Impacto pronóstico de la localización de la enfermedad aterosclerosa previa en pacientes diabéticos. Estudio Barbanza-diabetes.

INTRODUCTION AND OBJECTIVES: To assess the effect of different forms of atherosclerotic disease on prognosis in diabetic patients. METHODS: This multicenter prospective cohort study involved 1423 consecutive patients with diabetes mellitus who were recruited by 31 primary care physicians. The patients' characteristics were recorded and they were followed up for 45 +/- 10 months. RESULTS: The mean age of the patients (50% male) was 66 years, 64% had hypertension, 70% had dyslipidemia, and 26% had had a previous cardiovascular event. By the end of follow-up, 81 (6.2%) had died, 40 (3%) of whom due to cardiovascular causes, and 393 (30%) had been hospitalized, 179 (14%) of whom for cardiovascular disease. Multivariate analysis identified the following factors as independent predictors of mortality: age (hazard ratio [HR]=1.08; 95% confidence interval [CI],1.05-1.11), previous cardiovascular disease (HR=2.15; 95% CI, 1.12-4.14) and diuretic treatment (HR=3.40; 95% CI, 1.76-6.56), while the prescription of an angiotensin-converting enzyme inhibitor or an angiotensin-receptor antagonist had a protective effect (HR=0.48; 95% CI, 0.25-0.93). Compared with diabetics without a previous cardiovascular event, the risk of a cardiovascular event during follow-up was greater in those with a history of either ischemic heart disease (HR=2.48; 95% CI, 1.51-4.07), cerebrovascular disease (HR=2.51; 95% CI, 1.28-4.92), or peripheral vascular disease (HR=1.46; 95% CI, 0.81-2.60). CONCLUSIONS: The increase in the risk of a cardiovascular event was similar in diabetics with ischemic heart disease and those with cerebrovascular disease. In both cases, the risk was more than double that in patients without a history of cardiovascular disease.

Impacto pronóstico de la localización de la enfermedad aterosclerosa previa en pacientes diabéticos. Estudio Barbanza-diabetes / Effect of the location of previous atherosclerotic disease on prognosis in diabetic patients. The Barbanza Diabetes Study

Introducción y objetivos. Evaluar las diferencias pronósticas de las distintas formas de presentación de la enfermedad aterosclerosa en pacientes diabéticos. Métodos. Estudio multicéntrico de cohortes prospectivas, en el que participaron 31 médicos de atención primaria que registraron las características de 1.423 pacientes diabéticos que acudieron de forma consecutiva a sus consultas y fueron seguidos durante 45 ± 10 meses. Resultados. Pacientes (el 50%, varones) con media de edad de 66 años, el 64% hipertensos, el 70% dislipémicos y el 26% con eventos cardiovasculares previos. Tras el período de seguimiento, fallecieron 81 (6,2%) pacientes, 40 (3%) por causa cardiaca, y reingresaron 393 (30%), 179 (14%) por causa cardiovascular. En el análisis multivariable, resultaron determinantes independientes de mortalidad: la edad (hazard ratio [HR] = 1,08; inter-valo de confianza [IC] del 95%, 1,05-1,11), tener enfermedad cardiovascular (HR = 2,15; IC del 95%, 1,12-4,14) y seguir tratamiento con diuréticos (HR = 3,40; IC del 95%, 1,76-6,56), mientras que la prescripción de inhibidores de la enzima de conversión de angiotensina y/o antagonistas de los receptores de angiotensina II resultó factor protector (HR = 0,48; IC del 95%, 0,25-0,93). En comparación con diabéticos sin evento cardiovascular previo, el riesgo de tener una complicación cardiovascular fue superior en los pacientes con antecedentes de cardiopatía isquémica (HR = 2,48; IC del 95%, 1,51-4,07), enfermedad cerebrovascular (HR = 2,51; IC del 95%, 1,28-4,92) y enfermedad vascular periférica (HR = 1,46; IC del 95%, 0,81-2,60). Conclusiones. El incremento del riesgo de complicaciones cardiovasculares es semejante entre los diabéticos con cardiopatía isquémica y con enfermedad cerebrovascular y más del doble respecto a diabéticos sin afección cardiovascular evidente (AU)

Introduction and objectives. To assess the effect of different forms of atherosclerotic disease on prognosis in diabetic patients. Methods. This multicenter prospective cohort study involved 1423 consecutive patients with diabetes mellitus who were recruited by 31 primary care physicians. The patients' characteristics were recorded and they were followed up for 45 (10) months. Results. The mean age of the patients (50% male) was 66 years, 64% had hypertension, 70% had dyslipidemia, and 26% had had a previous cardiovascular event. By the end of follow-up, 81 (6.2%) had died, 40 (3%) of whom due to cardiovascular causes, and 393 (30%) had been hospitalized, 179 (14%) of whom for cardiovascular disease. Multivariate analysis identified the following factors as independent predictors of mortality: age (hazard ratio [HR]=1.08; 95% confidence interval [CI], 1.05-1.11), previous cardiovascular disease (HR=2.15; 95% CI, 1.12-4.14) and diuretic treatment (HR=3.40; 95% CI, 1.76-6.56), while the prescription of an angiotensin-converting enzyme inhibitor or an angiotensin-receptor antagonist had a protective effect (HR=0.48; 95% CI, 0.25-0.93). Compared with diabetics without a previous cardiovascular event, the risk of a cardiovascular event during follow-up was greater in those with a history of either ischemic heart disease (HR=2.48; 95% CI, 1.51-4.07), cerebrovascular disease (HR=2.51; 95% CI, 1.28-4.92), or peripheral vascular disease (HR=1.46; 95% CI, 0.81-2.60). Conclusions. The increase in the risk of a cardiovascular event was similar in diabetics with ischemic heart disease and those with cerebrovascular disease. In both cases, the risk was more than double that in patients without a history of cardiovascular disease (AU)

[Changes in lipid profile after regular intake of canned fish. The influence of addition of isoflavones, omega-3 fatty acids and fitosterols]. / Modificaciones en el perfil lipídico tras el consumo regular de conservas de pescado. Influencia de la adición de isoflavonas, ácidos grasos omega-3 y fitoesteroles.

BACKGROUND AND OBJECTIVE: Changes in dietary habits are associated with an improvement of lipid profile. We decided to assess changes in lipid profile reached with a dietary enrichment with canned tuna in olive oil and compared them with those reached with canned tuna with additional supplementation. SUBJECTS AND METHOD: In a prospective, randomized, single blind study, 400 participants were assigned to a daily intake of canned tuna in olive oil alone (control group) or enriched with: isoflavones, omega-3 fatty acids of phytosterols, during three months. Plasmatic lipid levels were measured before and after intervention. Changes of lipid levels between basal and final visits and differences between the 4 types of supplementations were evaluated. RESULTS: The mean age of the study population was 53 years, 45% of them being males. In all 4 groups a significant reduction of total cholesterol, low-density lipoprotein (LDL)-cholesterol levels and total cholesterol/high-density lipoprotein (HDL)-cholesterol ratio was observed after 3 months of follow-up; there were no significant changes of triglycerides nor HDL-cholesterol levels. The comparison between different types of supplementation revealed that only phytosterols addition reached a greater reduction of total cholesterol and LDL-cholesterol levels than canned tuna in olive oil alone (p < 0.05), and the differences between the remaining 2 supplementations and the control group were not significant. CONCLUSIONS: Regular intake of enrichment with canned tuna supplementation is associated with improvement of lipid profile. The addition of isoflavones, omega-3 fatty acids or phytosterols supplementations increases fish consume effect, although only the enrichment with phytosterols reaches significantly better results.

Modificaciones en el perfil lipídico tras el consumo regular de conservas de pescado. Influencia de la adición de isoflavonas, ácidos grasos omega-3 y fitoesteroles / Changes in lipid profile after regular intake of canned fish. The influence of addition of isoflavones, omega-3 fatty acids and fitosterols

Fundamento y objetivo: Las modificaciones en los hábitos dietéticos se asocian a cambios favorables en el perfil lipídico. Se trató de comprobar las modificaciones lipídicas tras suplementación dietética con conservas de atún en aceite de oliva, comparando sus efectos con los del atún enriquecido con aditivos. Sujetos y método: Se ha realizado un estudio prospectivo, de 3 meses de duración, aleatorizado y simple ciego, en el que participaron 400 individuos distribuidos en 4 grupos para suplementar su dieta con conserva de atún en aceite de oliva y con aditivos (ácidos grasos omega-3, isoflavonas y fitoesteroles). Se comparó la concentración plasmática de lípidos antes y después de la intervención, así como su modificación entre los distintos grupos. Resultados: La edad media de los participantes fue de 53 años y el 45% eran varones. En los 4 grupos se constataron reducciones significativas de los valores plasmáticos de colesterol total, colesterol unido a lipoproteínas de baja densidad (cLDL) y cociente colesterol total/colesterol unido a lipoproteínas de alta densidad (cHDL) después de los 3 meses de suplementación dietética; no se modificaron los triglicéridos ni el cHDL. En el grupo que tomó el atún enriquecido con fitoesteroles, la reducción del colesterol total y cLDL fue significativamente mayor (p < 0,05) que en el grupo que tomó el atún en aceite de oliva; las diferencias entre los restantes grupos no fueron significativas. Conclusiones: El consumo regular de conserva de atún se acompaña de modificaciones favorables en el perfil lipídico. La adición de suplementos de isoflavonas, fitoesteroles y ácidos grasos omega-3 potencia el efecto del pescado, aunque con una eficacia significativamente mayor de los fitoesteroles

Background and objective: Changes in dietary habits are associated with an improvement of lipid profile. We decided to assess changes in lipid profile reached with a dietary enrichment with canned tuna in olive oil and compared them with those reached with canned tuna with additional supplementation. Subjects and method: In a prospective, randomized, single blind study, 400 participants were assigned to a daily intake of canned tuna in olive oil alone (control group) or enriched with: isoflavones, omega-3 fatty acids of phytosterols, during three months. Plasmatic lipid levels were measured before and after intervention. Changes of lipid levels between basal and final visits and differences between the 4 types of supplementations were evaluated. Results: The mean age of the study population was 53 years, 45% of them being males. In all 4 groups a significant reduction of total cholesterol, low-density lipoprotein (LDL)-cholesterol levels and total cholesterol/high-density lipoprotein (HDL)-cholesterol ratio was observed after 3 months of follow-up; there were no significant changes of triglycerides nor HDL-cholesterol levels. The comparison between different types of supplementation revealed that only phytosterols addition reached a greater reduction of total cholesterol and LDL-cholesterol levels than canned tuna in olive oil alone (p < 0.05), and the differences between the remaining 2 supplementations and the control group were not significant. Conclusions: Regular intake of enrichment with canned tuna supplementation is associated with improvement of lipid profile. The addition of isoflavones, omega-3 fatty acids or phytosterols supplementations increases fish consume effect, although only the enrichment with phytosterols reaches significantly better results