Lipoprotein (a) is a predictor of non-achievement of LDL-C goals in patients with chronic heart disease. / Lipoproteína (a) es un factor predictor de no consecución de objetivos de C-LDL en pacientes con cardiopatía isquémica crónica.

INTRODUCTION AND OBJECTIVES: Lipoprotein (a) [Lp(a)] concentration influences serum low-density lipoprotein cholesterol (LDL-C) levels. How it influences the achievement of LDL-C targets established in the guidelines is not well studied. Our aim was to know the prevalence of elevated Lp(a) levels in patients with coronary artery disease, and to assess its influence on the achievement of LDL-C targets. METHOD: We conducted a cross-sectional study in a cardiology department in Spain. A total of 870 patients with stable coronary artery disease had their lipid profile determined, including Lp(a). Patients were stratified into 2 groups according to Lp(a)>50mg/dL and Lp(a)≤50mg/dL. The association of Lp(a)>50mg/dL with achievement of LDL-C targets was assessed by logistic regression analysis. RESULTS: The prevalence of Lp(a)>50mg/dL was 30.8%. Patients with Lp(a)>50mg/dL had higher baseline (142.30±47.54 vs. 130.47±40.75mg/dL; p=0.0001) and current (72.91±26.44 vs. 64.72±25.30mg/dL; p=0.0001), despite the fact that they were treated with more high-potency statins (77.2 vs. 70.9%; p=0.058) and more combination lipid-lowering therapy (37.7 vs. 25.7%; p=0.001). The proportion of patients achieving target LDL-C was lower in those with Lp(a)>50mg/dL. Independent predictors of having elevated Lp(a) levels>50mg/dL were the use of high-potency statins (OR 1.5; 95% CI 1.08-2.14), combination lipid-lowering therapy with ezetimibe (OR 2.0; 95% CI 1.45-2.73) and failure to achieve a LDL-C ≤55mg/dL (OR 2.3; 95% CI 1.63-3.23). CONCLUSIONS: Elevated Lp(a) levels influence LDL-C levels and hinder the achievement of targets in patients at very high cardiovascular risk. New drugs that act directly on Lp(a) are needed in these patients.

Vaccine-carditis study: Spanish multicenter registry of inflammatory heart disease after COVID-19 vaccination.

INTRODUCTION AND OBJECTIVES: Vaccines against SARS-CoV-2 have been a major scientific and medical achievement in the control of the COVID-19 pandemic. However, very infrequent cases of inflammatory heart disease have been described as adverse events, leading to uncertainty in the scientific community and in the general population. METHODS: The Vaccine-Carditis Registry has included all cases of myocarditis and pericarditis diagnosed within 30 days after COVID-19 vaccination since August 1, 2021 in 29 centers throughout the Spanish territory. The definitions of myocarditis (probable or confirmed) and pericarditis followed the consensus of the Centers for Disease Control and the Clinical Practice Guidelines of the European Society of Cardiology. A comprehensive analysis of clinical characteristics and 3-month evolution is presented. RESULTS: From August 1, 2021, to March 10, 2022, 139 cases of myocarditis or pericarditis were recorded (81.3% male, median age 28 years). Most cases were detected in the 1st week after administration of an mRNA vaccine, the majority after the second dose. The most common presentation was mixed inflammatory disease (myocarditis and pericarditis). 11% had left ventricular systolic dysfunction, 4% had right ventricular systolic dysfunction, and 21% had pericardial effusion. In cardiac magnetic resonance studies, left ventricular inferolateral involvement was the most frequent pattern (58%). More than 90% of cases had a benign clinical course. After a 3-month follow-up, the incidence of adverse events was 12.78% (1.44% mortality). CONCLUSIONS: In our setting, inflammatory heart disease after vaccination against SARS-CoV-2 predominantly affects young men in the 1st week after the second dose of RNA-m vaccine and presents a favorable clinical course in most cases.

Modification of the Forms of Self-Determined Regulation and Quality of Life after a Cardiac Rehabilitation Programme: Tennis-Based vs. Bicycle Ergometer-Based.

BACKGROUND: The objective is to analyse and compare the effects of an adapted tennis cardiac rehabilitation programme and a classical bicycle ergometer-based programme on the type of motivation towards sports practice and quality of life in patients classified as low risk after suffering acute coronary syndrome. METHODS: The Behavioural Regulation in Exercise Questionnaire (BREQ-2) and Velasco's Qualityof Life Test were applied. The sample comprised 110 individuals (age = 55.05 ± 9.27) divided into two experimental groups (tennis and bicycle ergometer) and a control group. RESULTS: The intra-group analysis showed a significant increase between pre- and post-test results in intrinsic regulation in the tennis group and in the control group. In identified regulation, the bicycle ergometer group presented significant differences from the control group. On the other hand, in the external regulation variable, only the tennis group showed significant differences, which decreased. Significant improvements in all quality-of-life factors when comparing the pre-test period with the post-test period were only found in the experimental groups. As per the inter-group analysis, significant differences were observed in favour of the tennis group with respect to the control group in the variables of health, social relations and leisure, and work time as well as in favour of the bicycle ergometer group compared with the control group in the variables of health, sleep and rest, future projects and mobility. No significant differences were found in any of the variables between the tennis group and the bicycle ergometer group. CONCLUSION: It is relevant to enhance the practice of physical exercise in infarcted patients classified as low risk as it improves the forms of more self-determined regulation towards sporting practice and their quality of life.

Low-Density Lipoprotein Cholesterol Targets in Patients With Coronary Heart Disease in Extremadura (Spain): LYNX Registry.

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) contributes decisively to the development of cardiovascular disease (CVD). In the LYNX registry we determined the rate of achievement of the target value of LDL-C, the use of lipid-lowering therapy (LLT) and the predictive factors of not reaching the target in patients with stable coronary heart disease (CHD). METHODS: LYNX included consecutive patients with stable CHD treated at the University Hospital of Caceres, Extremadura (Spain) from September 2016 to September 2018, and those who must have an LDL-C target below 70 mg/dL according to the European Society of Cardiology (ESC) 2016 guidelines. The variables independently associated with the breach of the LDL-C objective were evaluated by multivariable logistic regression. RESULTS: A total of 674 patients with stable CHD were included. The average LDL-C levels were 68.3 ± 24.5 mg/dL, with 56.7% showing a level below 70 mg/dL. LLT was used by 96.7% of patients, 71.7% were treated with high-powered statins and 30.1% with ezetimibe. The risk of not reaching the target value of LDL-C was higher in women, in active smokers, and in those who had multivessel CHD or had atrial fibrillation. Patients with diabetes mellitus, those who took potent statins or co-administration treatment with ezetimibe were more likely to reach the target level of LDL-C. CONCLUSIONS: The treatment of dyslipidemia in patients with chronic CHD remains suboptimal; however, an increasing number of very high-risk patients achieve the LDL-C objective, although there is still enormous potential to improve cardiovascular outcome through the use of more intensive LLT.

Síndrome coronario agudo como primera manifestación de trombocitemia esencial: un reto para los cardiólogos / Acute coronary syndrome as the first manifestation of essential thrombocythaemia: A challenge for cardiologists

Presentamos el caso de un síndrome coronario agudo en un paciente de 30 años con trombocitemia esencial. Los síndromes coronarios agudos ocurren en el 9% de los casos en estos pacientes, y su manejo constituye todo un reto para el cardiólogo, en concreto, en cuanto a la elección del tratamiento antiagregante más adecuado y su duración, considerando que estos pacientes tienen por una parte un elevado riesgo trombótico y, además, un riesgo hemorrágico no despreciable

We present the case is presented of an acute coronary syndrome in a 30-year-old patient with essential thrombocythaemia. Acute coronary syndromes occur in 9% of cases in these patients, and their management constitutes a challenge for the cardiologist, specifically in terms of choosing the most appropriate antiplatelet therapy and its duration, taking into account that these patients have a high thrombotic risk, as well as a considerable haemorrhagic risk

Use of edoxaban in clinical practice: Comparison of data from the Spanish population in the ETNA-AF-Europe registry.

Aim: To ascertain the clinical profile and management of edoxaban in clinical practice. Materials & methods: Prospective, noninterventional postauthorization study of nonselected patients with atrial fibrillation treated with edoxaban from 12 European countries. Patients' baseline characteristics are presented. Results: A total of 13,638 patients (73.6 ± 9.5 years; 76.6/23.4% edoxaban 60/30 mg; CHA2DS2-VASc 3.1; 838 [6.1%] from Spain) were included. In Spain, the percentage of very elderly and fragile patients was greater and the risk of thromboembolism (CHA2DS2-VASc ≥2, 98.0 vs 87.3%; p < 0.001) and bleeding (HAS-BLED, 3.2 vs 2.7; p < 0.001) was greater in patients treated with edoxaban 30 mg. The proportion of patients taking edoxaban 30 mg was similar than in ENGAGE AF-TIMI 48. Conclusion: In Spain, patients treated with edoxaban were older and fragile.

Cambios en el síndrome coronario agudo en una década en un hospital de referencia provincial / Changes in acute coronary syndrome in a decade in a provincial referral hospital

Introducción y objetivo: Determinar el cambio en las características clínicas y pronósticas de pacientes ingresados por síndrome coronario agudo (SCA) durante un periodo de los años 2005 y 2015 en un hospital de referencia provincial. Material y método: Estudio observacional transversal que compara las características del SCA de los años 2005 y 2015. Se analizaron factores de riesgo cardiovascular, tratamientos al alta, complicaciones y mortalidad. Resultados: La incidencia de SCA en 2015 fue un 15,3% menor. La incidencia de hipertensión arterial, diabetes y dislipemia fue similar, pero hubo más fumadores en 2015 (25,9% vs 18,3%; p = 0,005). La reperfusión coronaria y la prescripción de tratamientos de prevención secundaria aumentaron respecto a 2005. La mortalidad hospitalaria fue similar. Conclusión: La incidencia de SCA ha disminuido en la última década en paralelo a una mejoría en el pronóstico relacionado con un uso más frecuente de los tratamientos recomendados en las guías

Introduction and objective: To determine the changes in the clinical and prognostic characteristics of patients admitted due to acute coronary syndrome (ACS) during the period between the years 2005 and 2015 in a provincial referral hospital. Material and method: Cross-sectional observational study was conducted comparing the characteristics of ACS between 2005 and 2015. An analysis was made of the cardiovascular risk factors, treatment at discharge, complications, and mortality. Results: The incidence of ACS in 2015 was 15.3% lower. The incidence of hypertension, diabetes and dyslipidaemia was similar, but there were more smokers in 2015 (25.9% vs 18.3%, P=.005). Coronary reperfusion and the prescription of secondary prevention treatments increased compared to 2005. Hospital mortality was similar. Conclusion: The incidence of ACS has decreased in the last decade, in parallel with an improvement in the prognosis related to a more frequent use of the treatments recommended in the guidelines

Nueva mutación en el gen ACTA2 (pMet84Val) en una familia con aneurismas de aorta familiares no sindrómicos / New mutation in the ACTA2 gene (pMet84Val) in a family with nonsyndromic familial aortic aneurysms

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Acute coronary syndrome as the first manifestation of essential thrombocythaemia: A challenge for cardiologists. / Síndrome coronario agudo como primera manifestación de trombocitemia esencial: un reto para los cardiólogos.

We present the case is presented of an acute coronary syndrome in a 30-year-old patient with essential thrombocythaemia. Acute coronary syndromes occur in 9% of cases in these patients, and their management constitutes a challenge for the cardiologist, specifically in terms of choosing the most appropriate antiplatelet therapy and its duration, taking into account that these patients have a high thrombotic risk, as well as a considerable haemorrhagic risk.

Changes in acute coronary syndrome in a decade in a provincial referral hospital. / Cambios en el síndrome coronario agudo en una década en un hospital de referencia provincial.

INTRODUCTION AND OBJECTIVE: To determine the changes in the clinical and prognostic characteristics of patients admitted due to acute coronary syndrome (ACS) during the period between the years 2005 and 2015 in a provincial referral hospital. MATERIAL AND METHOD: Cross-sectional observational study was conducted comparing the characteristics of ACS between 2005 and 2015. An analysis was made of the cardiovascular risk factors, treatment at discharge, complications, and mortality. RESULTS: The incidence of ACS in 2015 was 15.3% lower. The incidence of hypertension, diabetes and dyslipidaemia was similar, but there were more smokers in 2015 (25.9% vs 18.3%, P=.005). Coronary reperfusion and the prescription of secondary prevention treatments increased compared to 2005. Hospital mortality was similar. CONCLUSION: The incidence of ACS has decreased in the last decade, in parallel with an improvement in the prognosis related to a more frequent use of the treatments recommended in the guidelines.

Comunicación entre niveles asistenciales: una oportunidad de mejora en la prevención cardiovascular / Communication between levels of care: An opportunity for improvement in cardiovascular prevention

La existencia de una buena coordinación entre los distintos niveles asistenciales constituye un factor fundamental en el desarrollo de una asistencia sanitaria de calidad y eficiente. El médico de atención primaria es fundamental en la prevención secundaria de la enfermedad cardiovascular, y la estrecha colaboración entre atención primaria y cardiología constituye un factor clave en el control de la enfermedad cardiovascular. El proyecto CAPaCERES (Colaboración AP-Cardiología en Cáceres) pretende mejorar la coordinación entre atención primaria y cardiología desde la perspectiva del conocimiento mutuo y la mejora de la comunicación entre los profesionales que la desarrollan, y con ello a mejorar la calidad de la asistencia al paciente crónico con enfermedad cardiovascular

The existence of good coordination between the different levels of care is an essential factor in the development of quality and efficient healthcare. The primary care physician is fundamental in the secondary prevention of cardiovascular disease and the close collaboration between primary care and cardiology is a key factor in the control of cardiovascular disease. The CAPaCERES project (AP-Cardiology Collaboration in Cáceres) aims to improve the coordination between primary care and cardiology from the perspective of mutual knowledge and the improvement of communication between the professionals who develop it, and with that to improve the quality of care chronic patient with cardiovascular disease

Communication between levels of care: An opportunity for improvement in cardiovascular prevention. / Comunicación entre niveles asistenciales: una oportunidad de mejora en la prevención cardiovascular.

The existence of good coordination between the different levels of care is an essential factor in the development of quality and efficient healthcare. The primary care physician is fundamental in the secondary prevention of cardiovascular disease and the close collaboration between primary care and cardiology is a key factor in the control of cardiovascular disease. The CAPaCERES project (AP-Cardiology Collaboration in Cáceres) aims to improve the coordination between primary care and cardiology from the perspective of mutual knowledge and the improvement of communication between the professionals who develop it, and with that to improve the quality of care chronic patient with cardiovascular disease.

Obesity and risk of myocardial infarction in a sample of European males. Waist to-hip-ratio presents information bias of the real risk of abdominal obesity / Obesidad y riesgo de infarto de miocardio en una muestra de varones europeos. El índice cintura-cadera sesga el riesgo real de la obesidad abdominal

Background: Obesity is a coronary risk factor associated to myocardial infarction although waist to-hip-ratio has shown higher predictive power. Objective: The aim of this study was a Receiver Operating Characteristic anthropometric analysis in infarcted males to identify the strength of association for simple measurements, obesity and indicators such as, waist to-hip-ratios, waist to-height-ratios and conicity index. Methods:Case-control study of myocardial infarction in European males. One hundred and twelve cases and 112 controls aged 30-74 years were enrolled. We measured weight, height, waist circumference, umbilical waist circumference and hip circumference. We calculated various anthropometric indicators. We obtained the areas under the ROC curves, the odds ratio and correlations for measurements and anthropometric indicators. Results: Body mass index [AUC: 0.686, 95% CI (0.616-0.755); OR: 3.3], waist circumference [AUC: 0.734, 95% CI (0.668-0.800); OR: 5.7], height [AUC: 0.623, 95% CI (0.550-0.696); OR: 2.3], hip circumference [AUC: 0.555, 95% CI (0.479-0.631); OR: 1], waist to-hip-ratio [AUC: 0.796, 95% CI (0.737-0.855); OR: 9.9], umbilical waist to-hip-ratio [AUC: 0.830, 95% CI (0.729-0.847); OR: 5.5], umbilical waist to-height-ratio [AUC: 0.788, 95% CI (0.729-0.847); OR: 7.5], conicity index [AUC: 0.795; 95% CI (0.738-0.853); OR: 9]. The correlations for waist to-height-ratios and conicity index were strong (all r ≥ 0.85; p < 0.001). Conclusions: Waist and height are measurements of associated independent risk. Hip circumference does no show discriminatory power. Obesity and waist-ratios are associated to myocardial infarction with different strength. Between other indicators, general obesity is more weakly associated. Waist to-hip-ratios present the best ROC curves but it occur information bias of their predictive power of risk. Umbilical waist to-height-ratio and conicity index present high discriminatory power and the best anthropometric risk correlations that support its use for the identification of obesity as risk factor associated to myocardial infarction and in all strategies for coronary health promotion.

Introducción: la obesidad es un factor de riesgo asociado al infarto de miocardio aunque el índice cintura-cadera ha mostrado mayor poder predictivo. Objetivo: análisis antropométrico Receiver Operating Characteristic (ROC) en infartados para identificar la fuerza discriminatoria de mediciones, obesidad, ratios cintura-cadera, ratios cintura-talla e índice de conicidad. Métodos: estudio caso-control de infarto miocárdico en varones europeos. Ciento doce casos/112 controles de 30-74 años fueron reclutados. Se midieron: peso, talla, cintura, cintura umbilical y cadera. Se obtuvieron las áreas bajo la curva (ABC), las odds ratio y correlaciones de medidas e indicadores. Resultados: IMC [ABC: 0,686 (0,616-0,755); OR: 3,3], cintura [ABC: 0,734 (0,668-0,800); OR: 5,7], talla [ABC: 0,623 (0,550-0,696); OR: 2,3], cadera [ABC: 0,555 (0,479-0,631); OR: 1], cintura-cadera [ABC: 0,796 (0,737-0,855); OR: 9,9]; cintura umbilical-cadera [ABC:0,830 (0,775-0,885); OR: 5,5], cintura umbilical-talla [ABC: 0,788 (0,729-0,847); OR: 7,5]; conicidad [ABC: 0,795 (0,738-0,853); OR:9]. Cintura-talla y conicidad presentaron altas correlaciones de riesgo (todas r ≥ 0,85; p < 0,001). Conclusiones: cintura y talla son medidas con riesgo independiente asociado. La circunferencia de cadera no es discriminatoria. Obesidad e índices de cintura están asociados al infarto con diferente fuerza. La obesidad presenta una asociación débil. Los índices cintura-cadera presentan las mejores curvas ROC, pero sesgadas en su poder predictivo de riesgo. Cintura umbilical-talla y conicidad presentan alto poder discriminatorio y mejores correlaciones antropométricas de riesgo, por lo que se recomienda su uso en la identificación de la obesidad como factor asociado al infarto de miocardio y en todas las estrategias de promoción de la salud coronaria.

Obesidad y riesgo de infarto de miocardio en una muestra de varones europeos. El índice cintura-cadera sesga el riesgo real de la obesidad abdominal / Obesity and risk of myocardial infarction in a sample of European males. Waist to-hip-ratio presents information bias of the real risk of abdominal obesity

Introducción: la obesidad es un factor de riesgo asociado al infarto de miocardio aunque el índice cintura-cadera ha mostrado mayor poder predictivo. Objetivo: análisis antropométrico Receiver Operating Characteristic (ROC) en infartados para identificar la fuerza discriminatoria de mediciones, obesidad, ratios cintura-cadera, ratios cintura-talla e índice de conicidad. Métodos: estudio caso-control de infarto miocárdico en varones europeos. Ciento doce casos/112 controles de 30-74 años fueron reclutados. Se midieron: peso, talla, cintura, cintura umbilical y cadera. Se obtuvieron las áreas bajo la curva (ABC), las odds ratio y correlaciones de medidas e indicadores. Resultados: IMC [ABC: 0,686 (0,616-0,755); OR: 3,3], cintura [ABC: 0,734 (0,668-0,800); OR: 5,7], talla [ABC: 0,623 (0,550-0,696); OR: 2,3], cadera [ABC: 0,555 (0,479-0,631); OR: 1], cintura-cadera [ABC: 0,796 (0,737-0,855); OR: 9,9]; cintura umbilical-cadera [ABC:0,830 (0,775-0,885); OR: 5,5], cintura umbilical-talla [ABC: 0,788 (0,729-0,847); OR: 7,5]; conicidad [ABC: 0,795 (0,738-0,853); OR:9]. Cintura-talla y conicidad presentaron altas correlaciones de riesgo (todas r ≥ 0,85; p < 0,001). Conclusiones: cintura y talla son medidas con riesgo independiente asociado. La circunferencia de cadera no es discriminatoria. Obesidad e índices de cintura están asociados al infarto con diferente fuerza. La obesidad presenta una asociación débil. Los índices cintura-cadera presentan las mejores curvas ROC, pero sesgadas en su poder predictivo de riesgo. Cintura umbilical-talla y conicidad presentan alto poder discriminatorio y mejores correlaciones antropométricas de riesgo, por lo que se recomienda su uso en la identificación de la obesidad como factor asociado al infarto de miocardio y en todas las estrategias de promoción de la salud coronaria (AU)

Background: Obesity is a coronary risk factor associated to myocardial infarction although waist to-hip-ratio has shown higher predictive power. Objective: The aim of this study was a Receiver Operating Characteristic anthropometric analysis in infarcted males to identify the strength of association for simple measurements, obesity and indicators such as, waist to-hip-ratios, waist to-height-ratios and conicity index. Methods: Case-control study of myocardial infarction in European males. One hundred and twelve cases and 112 controls aged 30-74 years were enrolled. We measured weight, height, waist circumference, umbilical waist circumference and hip circumference. We calculated various anthropometric indicators. We obtained the areas under the ROC curves, the odds ratio and correlations for measurements and anthropometric indicators. Results: Body mass index [AUC: 0.686, 95% CI (0.616-0.755); OR: 3.3], waist circumference [AUC: 0.734, 95% CI (0.668-0.800); OR: 5.7], height [AUC: 0.623, 95% CI (0.550-0.696); OR: 2.3], hip circumference [AUC: 0.555, 95% CI (0.479-0.631); OR: 1], waist to-hip-ratio [AUC: 0.796, 95% CI (0.737-0.855); OR: 9.9], umbilical waist to-hip-ratio [AUC: 0.830, 95% CI (0.729-0.847); OR: 5.5], umbilical waist to-height-ratio [AUC: 0.788, 95% CI (0.729-0.847); OR: 7.5], conicity index [AUC: 0.795; 95% CI (0.738-0.853); OR: 9]. The correlations for waist to-height-ratios and conicity index were strong (all r ≥ 0.85; p < 0.001). Conclusions: Waist and height are measurements of associated independent risk. Hip circumference does no show discriminatory power. Obesity and waist-ratios are associated to myocardial infarction with different strength. Between other indicators, general obesity is more weakly associated. Waist to-hip-ratios present the best ROC curves but it occur information bias of their predictive power of risk. Umbilical waist to-height-ratio and conicity index present high discriminatory power and the best anthropometric risk correlations that support its use for the identification of obesity as risk factor associated to myocardial infarction and in all strategies for coronary health promotion (AU)

Hypersensitivity perimyocarditis after the first dose of infliximab

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