Subclinical atheromatosis localization and burden in a low-to-moderate cardiovascular risk population: the ILERVAS study.

INTRODUCTION AND OBJECTIVES: There is a discrepancy between risk assessment based on cardiovascular risk factors (CVRF) and atheromatosis burden. The objective was to identify the prevalence of subclinical diseases with common risk factors, such as atheromatosis, occult kidney disease, prediabetes, and diabetes in a middle-aged population with low-to-moderate cardiovascular risk; to assess the vascular distribution, and severity of subclinical atheromatosis. METHODS: Randomized, interventional, longitudinal clinical trial. The intervention consisted of vascular ultrasound examination in the carotid and femoral arteries assessing 12 territories, combined with clinical, anthropometric, lifestyle, and biochemical parameters. Inclusion criteria consisted of women (aged 50-70 years) and men (aged 45-65 years) with at least 1 CVRF. Exclusion criteria consisted of a clinical history of diabetes, chronic kidney disease, or a prior CV event. Here, baseline characteristics of the ILERVAS cohort are shown. RESULTS: A total of 8330 middle-aged asymptomatic participants, 50.7% women, were enrolled. The presence of 1-2 CVRF was found in 74.8% and adherence to the Mediterranean diet was low in 52.8%. Several previously unknown chronic diseases were diagnosed, such as dyslipidemia (21.1%), hypertension (15.3%), kidney disease (15.4%), obesity (10.6%), and diabetes (2.3%). Subclinical atheromatosis was found in 71.4% of participants, localized in common femoral (54.5%), carotid bifurcation (41.1%) and internal carotid (22%). Intermediate atheromatosis (2-3 territories with atheroma plaque) was found in 32.6%, and generalized atheromatosis (>3 territories) in 19.7. Total plaque area was higher in men (0.97 cm2 vs 0.58 cm2, P<.001). Total plaque area was also higher in the femoral artery, and increased with the number of CVRF. CONCLUSIONS: Subclinical atheromatosis was highly prevalent in a middle-aged population with low-to moderate cardiovascular risk, with 1 in 5 participants having generalized atheromatosis. ClinicalTrials.gov Identifier: NCT03228459.

Skin Autofluorescence Measurement in Subclinical Atheromatous Disease: Results from the ILERVAS Project.

AIM: Advanced glycation end-products (AGEs) have been involved in the atherogenic process in the high-risk population. The goal of this study was to demonstrate that AGEs are related to subclinical atheromatous disease in subjects with low to moderate vascular risk. METHODS: A cross-sectional study in which 2,568 non-diabetic subjects of both sexes without cardiovascular disease were included. Subcutaneous content of AGEs was assessed by skin autofluorescence (SAF) and subclinical atheromatous disease was measured by assessing the atheromatous plaque burden in carotid and femoral regions using ultrasonography. In addition, serum pentosidine, carboxymethyl-lysine (CML) and AGE receptors (RAGE) were assessed in a nested case-control study with 41 subjects without plaque and 41 individuals subjects with generalized disease. RESULTS: Patients with atheromatous plaque had a higher SAF than those with no plaque (1.9 [1.7 to 2.3] vs. 1.8 [1.6 to 2.1] arbitrary units (AU), p＜0.001). The SAF correlated with the total number of affected regions (r= 0.171, p＜0.001), increasing progressively from 1.8 [1.6 to 2.1] AU in those without atheromatous disease to 2.3 [1.9 to 2.7] AU in patients with ≥ 8 plaques (p＜0.001). A correlation was also observed between SAF and the total plaque area (r=0.113, p＜0.001). The area under the Receiver Operating Characteristic curve was 0.65 (0.61 to 0.68) for identifying male subjects with atheromatous disease. The multivariable logistic regression model showed a significant and independent association between SAF and the presence of atheromatous disease. However, no significant differences in serum pentosidine, CML, and RAGE were observed. CONCLUSIONS: Increased subcutaneous content of AGEs is associated with augmented atheromatous plaque burden. Our results suggest that SAF may provide clinically relevant information to the current strategies for the evaluation of cardiovascular risk, especially among the male population.

Fractura de cadera en el paciente anciano: factores pronóstico de mortalidad y recuperación funcional al año / Hip fracture in the elderly patient: Prognostic factors for mortality and functional recovery at one year

Objetivo: El objetivo del estudio es identificar los factores pronóstico de mortalidad y de recuperación funcional en pacientes ancianos con fractura de cadera. Material y métodos: Estudio longitudinal prospectivo en pacientes de 80 años o más y pacientes entre 75 y 79 años institucionalizados en residencia, con antecedentes de demencia o en seguimiento por Geriatría, con fractura de cadera. Se incluyó a 359 pacientes, recogiéndose variables demográficas, situación funcional previa, antecedentes patológicos y tipo de fractura, y durante la hospitalización el momento de la cirugía, delirium, evolución funcional, estancia mediana, destino al alta y mortalidad. Se realizó seguimiento durante un año registrando ubicación del paciente, situación funcional, complicaciones médicas y mortalidad. Resultados: Las características basales que conferían mayor riesgo de mortalidad fueron la edad elevada (> 92 años), las complicaciones médicas que retrasaron la IQ (HR 2,17; IC del 95%, 1,27-3,73), tener demencia (HR 1,78; IC del 95%, 1,15-2,75) o insuficiencia cardiaca (HR 1,75; IC del 95%, 1,12-2,75). Los modelos de regresión multivariante ajustados muestran que la dependencia funcional previa a la fractura o la falta de recuperación funcional tras la misma, se asociaron a mayor mortalidad y que los pacientes de mayor edad, con delirium, demencia y dependencia funcional previa presentaron peor pronóstico de recuperación funcional. Conclusión: En los pacientes ancianos con una fractura de cadera, la edad elevada, la comorbilidad y la dependencia funcional se asocian a la mortalidad. El pronóstico de recuperación funcional dependerá de la edad, la situación funcional previa, los antecedentes de demencia y la presencia de delirium durante el ingreso

The aim of this study is to identify the risks factors for mortality and functional recovery in elderly patients admitted to hospital with a hip fracture. Materials and methods: Longitudinal prospective study in patients 80 years old or more and patients between 75 and 79 in residential home care with a hip fracture and with a past medical history of dementia or followed-up by the Geriatric Unit. A total of 359 patients were included, and the demographic data, previous functional status, comorbidity, type of fracture, and dementia were recorded. The data collected during admission included time to surgery, delirium, functional recovery, length of stay, placement at discharge, and mortality. Patients were followed-up for one year and details were collected on placement at the end of follow-up, functional recovery, medical complications, and mortality. Results: The baseline characteristics of the patients with a strong association with mortality after a hip fracture were old age (> 92 years), medical complications delaying surgery (HR 2.17; 95% CI; 1.27-3.73), diagnosis of dementia (HR 1.78; 95% CI; 1.15-2.75), or heart failure (HR 1.75; 95% CI; 1.12-2.75). The fitted multivariable regression models showed that functional impairment before the hip fracture or lack of functional recovery are associated with higher mortality, and patients with increased age, delirium, dementia, and previous functional impairment showed worse functional recovery. Conclusion: In the elderly patients with a hip fracture, increased age, comorbidity and previous functional status is associated with mortality. Functional recovery prognosis will depend on age, previous functional status, past medical history of dementia, and the presence of delirium during admission

[Hip fracture in the elderly patient: Prognostic factors for mortality and functional recovery at one year]. / Fractura de cadera en el paciente anciano: factores pronóstico de mortalidad y recuperación funcional al año.

OBJECTIVE: The aim of this study is to identify the risks factors for mortality and functional recovery in elderly patients admitted to hospital with a hip fracture. MATERIALS AND METHODS: Longitudinal prospective study in patients 80 years old or more and patients between 75 and 79 in residential home care with a hip fracture and with a past medical history of dementia or followed-up by the Geriatric Unit. A total of 359 patients were included, and the demographic data, previous functional status, comorbidity, type of fracture, and dementia were recorded. The data collected during admission included time to surgery, delirium, functional recovery, length of stay, placement at discharge, and mortality. Patients were followed-up for one year and details were collected on placement at the end of follow-up, functional recovery, medical complications, and mortality. RESULTS: The baseline characteristics of the patients with a strong association with mortality after a hip fracture were old age (> 92 years), medical complications delaying surgery (HR 2.17; 95% CI; 1.27-3.73), diagnosis of dementia (HR 1.78; 95% CI; 1.15-2.75), or heart failure (HR 1.75; 95% CI; 1.12-2.75). The fitted multivariable regression models showed that functional impairment before the hip fracture or lack of functional recovery are associated with higher mortality, and patients with increased age, delirium, dementia, and previous functional impairment showed worse functional recovery. CONCLUSION: In the elderly patients with a hip fracture, increased age, comorbidity and previous functional status is associated with mortality. Functional recovery prognosis will depend on age, previous functional status, past medical history of dementia, and the presence of delirium during admission.