Consensus on lipoprotein(a) of the Spanish Society of Arteriosclerosis. Literature review and recommendations for clinical practice. / Consenso sobre lipoproteína (a) de la Sociedad Española de Arteriosclerosis. Revisión bibliográfica y recomendaciones para la práctica clínica.

The irruption of lipoprotein(a) (Lp(a)) in the study of cardiovascular risk factors is perhaps, together with the discovery and use of proprotein convertase subtilisin/kexin type 9 (iPCSK9) inhibitor drugs, the greatest novelty in the field for decades. Lp(a) concentration (especially very high levels) has an undeniable association with certain cardiovascular complications, such as atherosclerotic vascular disease (AVD) and aortic stenosis. However, there are several current limitations to both establishing epidemiological associations and specific pharmacological treatment. Firstly, the measurement of Lp(a) is highly dependent on the test used, mainly because of the characteristics of the molecule. Secondly, Lp(a) concentration is more than 80% genetically determined, so that, unlike other cardiovascular risk factors, it cannot be regulated by lifestyle changes. Finally, although there are many promising clinical trials with specific drugs to reduce Lp(a), currently only iPCSK9 (limited for use because of its cost) significantly reduces Lp(a). However, and in line with other scientific societies, the SEA considers that, with the aim of increasing knowledge about the contribution of Lp(a) to cardiovascular risk, it is relevant to produce a document containing the current status of the subject, recommendations for the control of global cardiovascular risk in people with elevated Lp(a) and recommendations on the therapeutic approach to patients with elevated Lp(a).

Control lipídico en pacientes con enfermedad coronaria del Área de Salud de Cáceres (España): estudio LIPICERES / Lipid control in patients with coronary artery disease in a healthcare area in Cáceres (Spain): LIPICERES study

Introducción y objetivos: En pacientes con enfermedad coronaria las guías establecen como objetivo un colesterol asociado a lipoproteínas de baja densidad (cLDL) <70mg/dl. A pesar de las evidencias del beneficio de un estricto control lipídico, el grado de consecución de objetivos es alarmantemente bajo en los estudios más recientes. Hemos analizado el grado de cumplimiento de objetivos lipídicos en pacientes coronarios de nuestra área sanitaria. Métodos: Estudio observacional y transversal realizado en el Área de Salud de Cáceres (España). Se incluyeron 741 pacientes coronarios ingresados entre 2009-2015 con un perfil lipídico en los últimos 3 años. Se analizaron: colesterol total, cLDL, colesterol asociado a lipoproteínas de alta densidad (cHDL), triglicéridos (TG) y colesterol-no-HDL. Resultados: El 74,4% eran varones. La edad media fue de 68,5±13,1 años: 76,3 ± 11,8 en las mujeres y 65,8 ± 12,6 en los varones (p < 0,001). El 52,3% tenían un cLDL < 70 mg/dl, sin diferencias entre sexos; estaban en objetivos el 44,8% de los pacientes < 55 años frente al 59,3% de los > 75 años. Tenían un cHDL > 40 mg/dl el 68,2% de los varones y un cHDL > 50 mg/dl el 54,8% de las mujeres. Mostraron unos TG < 150 mg/dl el 79,4%, sin diferencias entre sexos, y un colesterol-no-HDL< 100 mg/dl el 59,8%. Conclusiones: La mitad de pacientes coronarios no alcanzan los objetivos de control lipídico, y esta proporción es muy inferior a la comunicada en estudios previos. No existen diferencias en el cumplimiento de objetivos por sexos, y la edad es un predictor de cumplimiento

Introduction and objectives: Current guidelines recommend a low-density lipoprotein cholesterol (LDLc) target of < 70 mg/dl for patients with coronary artery disease. Despite the well-established benefits of strict lipid control, the most recent studies show that control rate of lipid targets are alarmingly low. An analysis was performed on the lipid targets attained according to current guidelines for the prevention of cardiovascular disease in coronary patients in a Caceres healthcare area. Methods: An observational and cross-sectional study was carried out in a healthcare area in Caceres (Spain). The study included a total of 741 patients admitted for coronary disease between 2009 and 2015 with available lipid profile in the last 3 years Total cholesterol, high-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), triglycerides (TG) and non-HDLc were analysed. Results: The majority (74.4%) of patients were male, with a mean age of 68.5±13.1 years; 76.3 ± 11.8 for women and 65.8 ± 12.6 for men (P < .001). A total of 52.3% patients achieved the LDLc target of < 70 mg/dl, with no gender differences. Only 44.8% of the patients < 55 years achieved their lipid targets, compared to 59.3% of the patients > 75 years. About 68.2% of men had an HDLc > 40 mg/dl, and 54.8% of women had an HDLc > 50 mg/dl. Overall, 79.4% of patients had a TG < 150 mg/dl, with no gender differences, and 59.8% had a non-HDLc < 100 mg/dl. Conclusions: Approximately one half of patients with coronary disease do not achieve their target lipid levels as defined in the European guidelines, and this rate is less than reported in previous studies. There are no gender differences in achieving lipid goals, and age is a predictor of adherence (AU)

[Lipid control in patients with coronary artery disease in a healthcare area in Cáceres (Spain): LIPICERES study]. / Control lipídico en pacientes con enfermedad coronaria del Área de Salud de Cáceres (España): estudio LIPICERES.

INTRODUCTION AND OBJECTIVES: Current guidelines recommend a low-density lipoprotein cholesterol (LDLc) target of <70mg/dl for patients with coronary artery disease. Despite the well-established benefits of strict lipid control, the most recent studies show that control rate of lipid targets are alarmingly low. An analysis was performed on the lipid targets attained according to current guidelines for the prevention of cardiovascular disease in coronary patients in a Caceres healthcare area. METHODS: An observational and cross-sectional study was carried out in a healthcare area in Caceres (Spain). The study included a total of 741 patients admitted for coronary disease between 2009 and 2015 with available lipid profile in the last 3 years Total cholesterol, high-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), triglycerides (TG) and non-HDLc were analysed. RESULTS: The majority (74.4%) of patients were male, with a mean age of 68.5±13.1 years; 76.3±11.8 for women and 65.8±12.6 for men (P<.001). A total of 52.3% patients achieved the LDLc target of <70mg/dl, with no gender differences. Only 44.8% of the patients <55 years achieved their lipid targets, compared to 59.3% of the patients >75 years. About 68.2% of men had an HDLc>40mg/dl, and 54.8% of women had an HDLc>50mg/dl. Overall, 79.4% of patients had a TG<150mg/dl, with no gender differences, and 59.8% had a non-HDLc<100mg/dl. CONCLUSIONS: Approximately one half of patients with coronary disease do not achieve their target lipid levels as defined in the European guidelines, and this rate is less than reported in previous studies. There are no gender differences in achieving lipid goals, and age is a predictor of adherence.

Radioterapia supradiafragmática y bloqueo auriculoventricular completo / Supradiaphragmatic radiotherapy and complete atrioventricular block

El uso de la radioterapia ha contribuido a mejorar la supervivencia de pacientes con diversos tumores malignos relacionados con la región torácica. No obstante, la irradiación cardíaca a una dosis suficientemente alta puede dañar prácticamente cualquier componente del mismo, incluyendo el sistema de conducción. Se describe el caso de un paciente que desarrolló bloqueo auriculoventricular completo, más de veinte años después de recibir radioterapia supradiafragmática para el tratamiento de un linfoma de Hodgkin.

The use of radiotherapy has contributed to improving the survival in patients with diverse malignancies related to the thoracic region. Nevertheless, cardiac radiation in sufficiently high dose can damage virtually any of its components, including the conduction system. We describe the case of a patient who developed a complete atrioventricular block more than twenty years after receiving supradiaphragmatic radiotherapy for Hodgkin lymphoma.

Enfermedad de Castleman que infiltra grandes vasos y aurícula derecha / Castleman disease infiltrating great vessels and right atrium

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Enfermedad arterial periférica: eficacia del método oscilométrico / Peripheral arterial disease: efficacy of the oscillometric method

La seguridad para determinar el índice tobillo-brazo con método Doppler o con un aparato automático convencional de medir la presión arterial no está bien establecida cuando realizan la determinación médicos con poca experiencia. Para evaluar la eficacia diagnóstica de cada método en este grupo profesional, calculamos mediante angiografía la sensibilidad, la especificidad y los valores predictivos positivo y negativo en 158 piernas de 85 pacientes con síntomas de claudicación intermitente. Del total de piernas analizadas, 131 (83%) presentaron obstrucción significativa. El método oscilométrico mostró sensibilidad del 97%, especificidad del 89%, valor predictivo positivo del 98% y valor predictivo negativo del 86%. El método Doppler mostró sensibilidad del 95%, especificidad del 56%, valor predictivo positivo del 91% y valor predictivo negativo del 68%. Los resultados indican que el equipo automático de presión arterial tiene mejor rentabilidad diagnóstica cuando realizan la prueba médicos no especialmente entrenados en el manejo de la sonda Doppler (AU)

Relatively little is known on how the Doppler method compares with oscillometric measurement using a conventional automatic blood pressure device to determine the ankle-brachial index, when determinations are performed by physicians with little experience. To assess the diagnostic efficacy of both methods in this professional group, we calculated their sensitivity, specificity, and positive and negative predictive value in 158 legs of 85 patients with symptoms of intermittent claudication. Angiography was used as the gold standard. Of the legs examined, 131 showed significant arterial obstruction. The oscillometric method showed 97% sensitivity, 89% specificity, 98% positive predictive value, and 86% negative predictive value. The Doppler method showed 95% sensitivity, 56% specificity, 91% positive predictive value, and 68% negative predictive value. This study suggests that the automatic blood pressure equipment has greater diagnostic accuracy when the test is performed by physicians not specifically trained to use the Doppler probe (AU)

[Peripheral arterial disease: efficacy of the oscillometric method]. / Enfermedad arterial periférica: eficacia del método oscilométrico.

Relatively little is known on how the Doppler method compares with oscillometric measurement using a conventional automatic blood pressure device to determine the ankle-brachial index, when determinations are performed by physicians with little experience. To assess the diagnostic efficacy of both methods in this professional group, we calculated their sensitivity, specificity, and positive and negative predictive value in 158 legs of 85 patients with symptoms of intermittent claudication. Angiography was used as the gold standard. Of the legs examined, 131 showed significant arterial obstruction. The oscillometric method showed 97% sensitivity, 89% specificity, 98% positive predictive value, and 86% negative predictive value. The Doppler method showed 95% sensitivity, 56% specificity, 91% positive predictive value, and 68% negative predictive value. This study suggests that the automatic blood pressure equipment has greater diagnostic accuracy when the test is performed by physicians not specifically trained to use the Doppler probe. Full English text available from: www.revespcardiol.org.

Prevalencia de síndrome metabólico en Extremadura (España) / Prevalence of metabolic syndrome in Extremadura, Spain

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Síndrome metabólico y enfermedad cardiovascular en la provincia de Cáceres: estudio SIMCERES / Metabolic syndrome and cardiovascular disease in the province of Caceres (Spain): the SIMCERES study

Introducción y objetivos El síndrome metabólico (SM) confiere un riesgo cardiovascular elevado a los individuos que lo padecen. El objetivo del estudio SIMCERES fue determinar la prevalencia de SM en pacientes con enfermedad cardiovascular (ECV) previa (cardiopatía isquémica, ictus y enfermedad arterial periférica), definido éste por los criterios de la National Cholesterol Education Program/Adult Treatment Panel (ATP) III y la Federación Internacional de Diabetes (IDF). Métodos Se eligió al azar mediante muestreo aleatorio usando el código de identificación de asistencia sanitaria de los médicos de atención primaria una muestra poblacional de 1.498 individuos mayores de 14 años de la provincia de Cáceres. Se les hicieron las determinaciones necesarias para realizar el diagnóstico de SM según criterios del ATP-III y la IDF, y se los interrogó sobre antecedentes personales y familiares de ECV. Se detectó a 204 individuos con ECV previa, un 13,6% de la población. Resultados La prevalencia de SM en individuos con ECV fue del 32,8% según criterios del ATP-III y del 42,6% según criterios de la IDF con una edad media de 72,26±12,61 años según el ATP-III y de 70,99±13,05 años según la IDF, sin que hubiera diferencias entre varones y mujeres en ninguna de las 2 definiciones. Se encontró asociación estadística entre la presencia de ECV y SM, tanto con los criterios del ATP-III (odds ratio ATP-III: 3,2/intervalo de confianza 95%: 2,29–4,47) como con los criterios de la IDF (odds ratio IDF: 3,08/intervalo de confianza 95%: 2,26–4,2) (p<0,0001). Conclusiones El SM es muy prevalente en la población de la provincia de Cáceres con ECV previa, y dicha prevalencia aumenta con la edad de la población, siendo igual en ambos sexos (AU)

Introduction and objectives Metabolic syndrome confers high cardiovascular risk in affected individuals. The objective of the SIMCERES study was to determine the prevalence of metabolic syndrome in patients with prior cardiovascular disease (ischemic heart disease, stroke and peripheral arterial disease), defined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) and International Diabetes Federation (IDF). Methods A population-based sample of 1498 persons aged more than 14 years old from the province of Caceres was randomly chosen using the healthcare identification code of primary care physicians. The determinations required to make a diagnosis of metabolic syndrome according to ATP-III and IDF criteria were performed and participants were questioned about their personal and family history of cardiovascular disease. Prior cardiovascular disease was detected in 204 individuals, representing 13.6% of the population. Results The prevalence of metabolic syndrome in persons with cardiovascular disease was 32.8% according to ATP-III criteria and 42.6% according to IDF criteria, with a mean age of 72.26±12.61 years (ATP-III criteria) and 70.99±13.05 years (IDF criteria). There were no differences between men and women in either of the two definitions. A statistically significant association was found between the presence of cardiovascular disease and metabolic syndrome, with both the ATP-III criteria (OR ATP-III: 3.2/95% CI 2.29–4.47) and the IDF criteria (OR IDF: 3.08/95%: 2.26–4.2) (p<0.0001).Conclusions Metabolic syndrome is highly prevalent in the population of the province of Caceres with prior cardiovascular disease. The prevalence of this syndrome increases with the age of the population and is the same in both sexes (AU)

Síndrome coronario agudo en mujer joven tratada con sibutramina / Acute coronary syndrome in a young woman treated with sibutramine

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Torsade de pointes por QT largo en el contexto de dieta muy baja en calorías / No disponible

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