Situs inversus totalis asociado a síndrome de preexcitación ventricular: reporte de un caso / Situs inversus totalis and pre excitation syndrome

Resumen: El situs inversus totalis es la inversión congénita completa de órganos torácicos y abdominales. Se presenta el caso de una paciente de 3 años sin antecedentes médicos previos, a quien en atención primaria, y por un cuadro respiratorio agudo, se evidencia el hallazgo de dextrocardia y burbuja gástrica a derecha en la radiografía de tórax, sospechándose situs inversus totalis. Fue derivada a cardiología infantil donde se confirmó el diagnóstico con un ecocardiograma transtorácico, asociado a un hallazgo de preexcitación ventricular en el electrocardiograma. Una vez resuelto el cuadro respiratorio agudo, la paciente se mantiene controlada de manera periódica en atención primaria y por especialista de manera semestral.

Abstract: Situs inversus totalis is the complete congenital inversion of thoracic and abdominal organs. We present the case of a 3-year-old girl with no previous medical history. When seen with an acute respiratory syndrome, dextrocardia and gastric bubble on the right side led to the diagnosis of Situs inversus. She was referred to infant cardiology where the diagnosis was confirmed with a transthoracic echocardiogram. In addition, the electrocardiogram identified the presence of ventricular preexitation. Once the acute respiratory symptoms subsided, the patient remains controlled periodically in primary care and by a specialist every six months. No episodes of tachycardia have been detected.

Clinical course and prognostic factors of COVID-19 infection in an elderly hospitalized population.

INTRODUCTION: Older subjects have a higher risk of COVID-19 infection and a greater mortality. However, there is a lack of studies evaluating the characteristics of this infection at advanced age. PATIENTS AND METHODS: We studied 404 patients ≥ 75 years (mean age 85.2 ±â€¯5.3 years, 55 % males), with PCR-confirmed COVID-19 infection, attended in two hospitals in Madrid (Spain). Patients were followed-up until they were discharged from the hospital or until death. RESULTS: Symptoms started 2-7 days before admission, and consisted of fever (64 %), cough (59 %), and dyspnea (57 %). A total of 145 patients (35.9 %) died a median of 9 days after hospitalization. In logistic regression analysis, predictive factors of death were age (OR 1.086; 1.015-1.161 per year, p = 0.016), heart rate (1.040; 1.018-1.061 per beat, p < 0.0001), a decline in renal function during hospitalization (OR 7.270; 2.586-20.441, p < 0.0001) and worsening dyspnea during hospitalization (OR 73.616; 30.642-176.857, p < 0.0001). Factors predicting survival were a female sex (OR 0.271; 0.128-0.575, p = 0.001), previous treatment with RAAS inhibitors (OR 0.459; 0.222-0.949, p = 0.036), a higher oxygen saturation at admission (OR 0.901; 0.842-0.963 per percentage point increase, p = 0.002), and a greater platelet count (OR 0.995; 0.991-0.999 per 106/L, p = 0.025). CONCLUSION: Elderly patients with COVID-19 infection have a similar clinical course to younger individuals. Previous treatment with RAAS inhibitors, and demographic, clinical and laboratory data influence prognosis.

Fenotipo de la haptoglobina y presencia de enfermedad vascular subclínica: estudio poblacional / Phenotype of haptoglobin and presence of subclinical vascular disease: Population study

Introducción y objetivos: La haptoglobina es una proteína implicada en la protección frente al daño oxidativo producido por el hierro de la hemoglobina. Esta proteína es polimórfica, con 3 isomorfas prevalentes en la población. Los portadores de la isoforma Hp2-2 tienen una menor capacidad antioxidante, y en la población con diabetes, un mayor riesgo de enfermedad vascular subclínica y de complicaciones cardiovasculares. Nuestro objetivo fue evaluar si dicha isomorfa se asocia con un mayor riesgo de arteriosclerosis carotídea en sujetos con y sin diabetes, libres de enfermedad cardiovascular. Pacientes y métodos: Estudio realizado en una población de entre 45 y 74años de edad seleccionada aleatoriamente del área noroeste de Madrid. Los participantes fueron caracterizados en cuanto a su estatus glucémico mediante una sobrecarga oral de glucosa y la determinación de la concentración de Hb1Ac. A todos ellos se les determinó el fenotipo de la haptoglobina mediante un ensayo inmunoenzimático y la presencia de arteriosclerosis carotídea mediante ecografía. Resultados: De los 1.256 participantes incluidos en el presente análisis (edad media 61,6 ± 6 años, 41,8% varones), la distribución de las isoformas de la haptoglobina fue la siguiente: Hp1-1: 13,3%, Hp1-2: 48,5% y Hp2-2: 38,2%. En comparación con los sujetos Hp1-1 y Hp1-2, aquellos con el fenotipo Hp2-2 tuvieron una mayor prevalencia de dislipemia (53,3% vs 43%, p < 0,0001) e hipertensión arterial (39,2% vs 32,2%, p = 0,012), y recibieron con más frecuencia tratamiento con estatinas (31,5% vs 21,6%, p < 0,0001) y con antihipertensivos (38,4% vs 30,8%, p = 0,006). Los portadores de la isoforma Hp2-2 tuvieron una mayor prevalencia de placas carotídeas (OR: 1,35; IC 95%: 1,07-1,69; p = 0,011), sin diferencias en dicha prevalencia en función del estatus glucémico. No existieron diferencias en el grosor íntima-media entre los diferentes fenotipos. La relación del fenotipo Hp2-2 con la presencia de placas en carótida fue independiente de la edad, del sexo, de la presencia de factores de riesgo (dislipemia, hipertensión y diabetes), de la concentración de colesterol LDL, proteína C reactiva y ácido úrico, de la presión arterial y del tratamiento con estatinas y antihipertensivos (OR: 1,31; IC 95%: 1,01-1,70; p = 0,044). Conclusión: Los sujetos con el fenotipo Hp2-2 de la haptoglobina tienen una mayor prevalencia de arteriosclerosis carotídea, que es independiente de la presencia de otros factores de riesgo cardiovascular y de su estatus glucémico

Introduction and objectives: Haptoglobin is a protein involved in the protection against oxidative damage caused by iron in haemoglobin. This protein is polymorphic, with 3 isomorphs prevalent in the population. The carriers of the Hp2-2 isoform have a lower antioxidant capacity and, in the population with diabetes, an increased risk of subclinical vascular disease and cardiovascular complications. The objective of this study was to evaluate whether this isomorphy is associated with an increased risk of carotid arteriosclerosis in subjects with and without diabetes, and free of cardiovascular disease. Patients and methods: A study was conducted in a population between 45 and 74years of age, randomly selected from the northwest area of Madrid. The participants were characterised in terms of their glycaemic status by oral glucose overload and the determination of the concentration of Hb1Ac. The haptoglobin phenotypes in all of them were determined by means of an immunoenzymatic assay, and the presence of carotid arteriosclerosis by ultrasound. Results: Of the 1,256 participants included in the present analysis (mean age 61.6 ± 6 years, 41.8% males), the distribution of the isoforms of haptoglobin was as follows: Hp1-1: 13.3%, Hp1-2: 48.5%, and Hp2-2: 38.2%. In comparison with subjects Hp1-1 and Hp1-2, those with the Hp2-2 phenotype had a higher prevalence of dyslipidaemia (53.3% vs 43%; P < .0001) and arterial hypertension (39.2% vs. 32.2%, P = .012), and they more frequently received treatment with statins (31.5% vs 21.6%, P < .0001), and with antihypertensive agents (38.4% vs 30.8%, P = .006). The carriers of the Hp2-2 isoform had a higher prevalence of carotid plaques (OR: 1.35, 95%CI: 1.07-1.69, P = .011), with no differences in that prevalence as regards the glycaemic status. There were no differences in the intima-media thickness between the different phenotypes. The relationship of the Hp2-2 phenotype with the presence of plaques in the carotid was independent of age, gender, presence of risk factors (dyslipidaemia, hypertension and diabetes), the concentration of LDL-cholesterol, C-reactive protein and uric acid, blood pressure, and treatment with statins, and hypertensive drugs (OR: 1.31, 95% CI 1.01-1.70, P = .044). Conclusion: Subjects with the Hp2-2 phenotype of haptoglobin have a higher prevalence of carotid arteriosclerosis, which is independent of the presence of other cardiovascular risk factors and their glycaemic status

Phenotype of haptoglobin and presence of subclinical vascular disease: Population study. / Fenotipo de la haptoglobina y presencia de enfermedad vascular subclínica: estudio poblacional.

INTRODUCTION AND OBJECTIVES: Haptoglobin is a protein involved in the protection against oxidative damage caused by iron in haemoglobin. This protein is polymorphic, with 3 isomorphs prevalent in the population. The carriers of the Hp2-2 isoform have a lower antioxidant capacity and, in the population with diabetes, an increased risk of subclinical vascular disease and cardiovascular complications. The objective of this study was to evaluate whether this isomorphy is associated with an increased risk of carotid arteriosclerosis in subjects with and without diabetes, and free of cardiovascular disease. PATIENTS AND METHODS: A study was conducted in a population between 45 and 74years of age, randomly selected from the northwest area of Madrid. The participants were characterised in terms of their glycaemic status by oral glucose overload and the determination of the concentration of Hb1Ac. The haptoglobin phenotypes in all of them were determined by means of an immunoenzymatic assay, and the presence of carotid arteriosclerosis by ultrasound. RESULTS: Of the 1,256 participants included in the present analysis (mean age 61.6±6years, 41.8% males), the distribution of the isoforms of haptoglobin was as follows: Hp1-1: 13.3%, Hp1-2: 48.5%, and Hp2-2: 38.2%. In comparison with subjects Hp1-1 and Hp1-2, those with the Hp2-2 phenotype had a higher prevalence of dyslipidaemia (53.3% vs 43%; P<.0001) and arterial hypertension (39.2% vs. 32.2%, P=.012), and they more frequently received treatment with statins (31.5% vs 21.6%, P<.0001), and with antihypertensive agents (38.4% vs 30.8%, P=.006). The carriers of the Hp2-2 isoform had a higher prevalence of carotid plaques (OR: 1.35, 95%CI: 1.07-1.69, P=.011), with no differences in that prevalence as regards the glycaemic status. There were no differences in the intima-media thickness between the different phenotypes. The relationship of the Hp2-2 phenotype with the presence of plaques in the carotid was independent of age, gender, presence of risk factors (dyslipidaemia, hypertension and diabetes), the concentration of LDL-cholesterol, C-reactive protein and uric acid, blood pressure, and treatment with statins, and hypertensive drugs (OR: 1.31, 95%CI 1.01-1.70, P=.044). CONCLUSION: Subjects with the Hp2-2 phenotype of haptoglobin have a higher prevalence of carotid arteriosclerosis, which is independent of the presence of other cardiovascular risk factors and their glycaemic status.

Caso de paraqueratosis pustulosa: entidad poco frecuente y síntoma de enfermedad inflamatoria del aparato ungueal en pacientes pediátricos / Case of pustular parakeratosis: a rare entity common and symptom of inflammatory disease of the nail apparatus in pediatric patients

La paraqueratosis pustulosa es una entidad poco descrita en la literatura y se define como un proceso inflamatorio cutáneo, ungueal y periungueal en el área distal de un dedo habitualmente pulgar o índice, frecuentemente en la infancia. Su evolución suele ser benigna y la respuesta a emolientes tópicos es favorable. A continuación, se presenta un caso de esta enfermedad con el objetivo de resaltar su consideración en patologías ungueales pediátricas.

Pustular parakeratosis is an entity scantly described in literature. It has been described as a skin, nail, and periungual inflammatory process in the distal area of a finger, usually the thumb or index finger, frequently in childhood. Its evolution is usually benign and management is favorable with topical emollients. A clinical case is presented, to raise awareness of this entity in pediatric nail pathologies.

R46L polymorphism in the PCSK9 gene: Relationship to lipid levels, subclinical vascular disease, and erectile dysfunction.

BACKGROUND: The R46L variant of the proprotein convertase subtilisin/kexin type 9 (PCSK9) gene has been related to lipid levels and cardiovascular disease. OBJECTIVE: To evaluate the influence of this polymorphism on subclinical vascular disease and erectile dysfunction (ED). METHODS: We analyzed the association of the PCSK9 rs11591147 single-nucleotide polymorphism with lipid levels, intima-media thickness (IMT), and the ankle-brachial index, in 1188 adults free of cardiovascular disease, randomly selected from the population. In 473 male participants, we also investigated its relationship with ED. The association of the R46L polymorphism with lipid levels was also assessed in 2 cohorts of 1103 prepuberal children and 830 adolescents. RESULTS: The prevalence of the T allele was 2.9% in adults. Low-density lipoprotein cholesterol (LDL-cholesterol) levels did not vary according to this polymorphism (134 ± 32 vs 134 ± 31 mg/dL, for the TT + GT vs GG carriers, respectively, P = .931). Despite equal LDL-cholesterol levels, adults carrying the T allele had a lower mean common carotid IMT (0.685 ± 0.09 vs 0.723 ± 0.127 mm; P = .035), a lower maximum common carotid IMT (0.819 ± 0.11 vs 0.865 ± 0.159 mm; P = .040), and, in males, a lower prevalence of ED (36.8% vs 61%: P = .036), than GG carriers. Prevalence of the T allele was 3.2% in both cohorts of children. They had lower levels of LDL-cholesterol than GG subjects (100 vs 109 mg/dL; P = .060, for prepuberal children, and 85 vs 99 mg/dL; P = .010 for adolescents). CONCLUSION: In our population, an association between the PCSK9 R46L variant and LDL-cholesterol levels is observed in children. In adults, although its association with lipid levels is not evident, there is a significant relationship between the PCSK9 R46L variant and markers of subclinical atherosclerosis, including IMT and ED.

Factores de riesgo asociados con el grosor íntima-media y la presencia de placas en arteria carótida: Estudio ESPREDIA / Risk factors associated with the carotid intima-media thickness and plaques: ESPREDIA Study

Objetivo: Evaluar si existen diferencias en el perfil de factores de riesgo asociados con el grosor íntima-media (GIM) y la presencia de placas carotídeas. Métodos: Estudio transversal de base poblacional, en 1.475 sujetos de entre 45 y 75años de edad, seleccionados de forma aleatoria de los registros de Atención Primaria del área noroeste de Madrid. Se les realizó una exploración física, una analítica y se les determinó el GIM en carótida común y la presencia de placas mediante ecografía. Resultados: El GIM medio de la población fue de 0,725±0,132mm. El 47% presentaban placas carotídeas. En el análisis multivariante, los factores relacionados con el GIM fueron: edad (β0,227, p<0,0001), sexo (β0,104, p<0,0001), presencia de hipertensión (β0,082, p=0,002), diabetes (β0,130, p<0,0001) y tabaquismo activo (β0,107, p<0,0001), presión arterial sistólica (PAS) (β0,219, p<0,0001) y concentración de colesterol LDL (β0,074, p=0,003), y de forma inversa, presión arterial diastólica (PAD) (β−0,124, p=0,001) y concentraciones de colesterol HDL (β−0,111, p<0,0001) y triglicéridos (β−0,060, p=0,028). La presencia de placas se asoció de forma directa con edad (OR1,08; IC95%: 1,05-1,10), sexo (OR1,95; IC95%: 1,52-2,51), tabaquismo activo (OR2,75; IC95%: 1,92-3,95), antecedente de hipertensión (OR1,58; IC95%: 1,22-2,04) y de diabetes (OR1,84; IC95%: 1,31-2,58), consumo de estatinas (OR1,56; IC95%: 1,19-2,04) y PAS (OR1,03; IC95%: 1,02-1,05), y de forma inversa con PAD (OR0,98; IC95%: 0,96-0,99). Conclusión: Los factores de riesgo asociados con el GIM y la presencia de placas son similares, un dato que apoya el continuo entre la hipertrofia de la capa muscular y el desarrollo de arteriosclerosis (AU)

Objective: To evaluate whether there were any differences in the risk factor profile associated with either the intima-media thickness (IMT) or the presence of carotid plaques. Methods: Cross-sectional study in 1475 subjects between 45 and 75years, randomly selected from the population of the Northwest area of Madrid (Spain). They had a physical exam, blood analysis, and ultrasound measurement of the IMT and of the presence of plaques. Results: Mean IMT was 0.725±0.132mm. Forty seven percent of the participants had carotid plaques. In multivariate analysis, factors directly associated with the IMT were, age (β0.227, P<.0001), sex (β0.104, P<.0001), presence of hypertension (β0.082, P=.002), diabetes (β0.130, P<.0001) and current smoking (β0.107, P<.0001), systolic blood pressure (SBP) (β0.219, P<.0001) and LDL-cholesterol levels (β0.074, P=.003), and inversely, diastolic blood pressure (DBP) (β−0.124, P=.001), HDL-cholesterol (β−0.111, P<.0001) and triglyceride levels (β−0.060, P=.028). The presence of plaques was directly associated with age (OR1.08; 95%CI: 1.05-1.10), sex (OR1.95; 95%CI: 1.52-2.51), current smoking (OR2.75; 95%CI: 1.92-3.95), history of hypertension (OR1.58; 95%CI: 1.22-2.04) or diabetes (OR1.84; 95%CI: 1.31-2.58), statin treatment (OR1.56; 95%CI: 1.19-2.04) and SBP (OR1.03; 95%CI: 1.02-1.05), and inversely with DBP (OR0.98; 95%CI: 0.96-0.99). Conclusion: Factors associated with the IMT and the presence of plaques are similar, a finding that support a continuum between muscular layer hypertrophy and arteriosclerosis development (AU)

Relationship of the Adherence to a Mediterranean Diet and Its Main Components with CRP Levels in the Spanish Population.

Background: Adherence to a Mediterranean diet seems to be inversely associated with C-reactive protein (CRP) concentration. A 14-point Mediterranean Diet Adherence Screener (MEDAS) has been developed to assess dietary compliance. Objective: The aim of this study was to assess whether each of the MEDAS questions as well as their final score were associated with the levels of CRP in general Spanish population. METHODS: Cross-sectional analysis of 1411 subjects (mean age 61 years, 43.0% males) randomly selected from the general population. CRP levels were determined by a commercial ELISA kit. Adherence to the Mediterranean diet was measured by the 14-point MEDAS. Results: There was an inverse correlation between adherence to the Mediterranean diet and the CRP concentration, even after adjusting by age, gender, hypertension, metabolic syndrome, body mass index, statin treatment and hypertension treatment (p = 0.041). Subjects who consume ≥2 servings of vegetables per day (p = 0.003), ≥3 pieces of fruit per day (p = 0.003), ≥1 serving of butter, margarine, or cream per day (p = 0.041) or ≥3 servings of fish/seafood per week (p = 0.058) had significantly lower levels of CRP. Conclusions: Adherence to a Mediterranean-type diet measured by a simple questionnaire is associated with lower CRP concentration. However, this association seems to be particularly related to a higher consumption of vegetables, fruits, dairy products, and fish.

Risk factors associated with the carotid intima-media thickness and plaques: ESPREDIA Study. / Factores de riesgo asociados con el grosor íntima-media y la presencia de placas en arteria carótida: Estudio ESPREDIA.

OBJECTIVE: To evaluate whether there were any differences in the risk factor profile associated with either the intima-media thickness (IMT) or the presence of carotid plaques. METHODS: Cross-sectional study in 1475 subjects between 45 and 75years, randomly selected from the population of the Northwest area of Madrid (Spain). They had a physical exam, blood analysis, and ultrasound measurement of the IMT and of the presence of plaques. RESULTS: Mean IMT was 0.725±0.132mm. Forty seven percent of the participants had carotid plaques. In multivariate analysis, factors directly associated with the IMT were, age (ß0.227, P<.0001), sex (ß0.104, P<.0001), presence of hypertension (ß0.082, P=.002), diabetes (ß0.130, P<.0001) and current smoking (ß0.107, P<.0001), systolic blood pressure (SBP) (ß0.219, P<.0001) and LDL-cholesterol levels (ß0.074, P=.003), and inversely, diastolic blood pressure (DBP) (ß-0.124, P=.001), HDL-cholesterol (ß-0.111, P<.0001) and triglyceride levels (ß-0.060, P=.028). The presence of plaques was directly associated with age (OR1.08; 95%CI: 1.05-1.10), sex (OR1.95; 95%CI: 1.52-2.51), current smoking (OR2.75; 95%CI: 1.92-3.95), history of hypertension (OR1.58; 95%CI: 1.22-2.04) or diabetes (OR1.84; 95%CI: 1.31-2.58), statin treatment (OR1.56; 95%CI: 1.19-2.04) and SBP (OR1.03; 95%CI: 1.02-1.05), and inversely with DBP (OR0.98; 95%CI: 0.96-0.99). CONCLUSION: Factors associated with the IMT and the presence of plaques are similar, a finding that support a continuum between muscular layer hypertrophy and arteriosclerosis development.

Peripheral Atherosclerosis in Patients With Erectile Dysfunction: A Population-Based Study.

INTRODUCTION: The presence of erectile dysfunction (ED) could be a warning of vascular disease in different arterial territories. AIM: The aim of this study was to investigate the association between ED and the presence of atherosclerosis in 2 different vascular beds: carotid and lower limbs. METHODS: A total of 614 volunteers between 45 and 74 years of age (mean age 61.0 years) were randomly selected from the general population. ED was assessed using the International Index of Erectile Function (IIEF-5). Ankle-brachial index (ABI) measurement and carotid atherosclerosis were evaluated by echo-Doppler. MAIN OUTCOME MEASURES: Mean carotid intima-media thickness (IMT), prevalence of carotid plaques, mean ABI, and prevalence of ABI < 0.9 were the main outcome measures. RESULTS: ED was present in 373 subjects (59.7%). Mean carotid IMT was significantly higher in men with ED (0.762 ± 0.151 mm vs 0.718 ± 0.114 mm, P < .001). Also the global prevalence of carotid plaques was more frequent in men with ED (63.8% vs 44.8%, P < .001), even after adjusting by age, cardiovascular risk factors, and ongoing treatment (P = .039). Both the IMT and the prevalence of carotid plaques increased significantly with ED severity (P trend .004 and <.001, respectively). There were no significant differences between groups neither in mean ABI nor in the prevalence of subjects with ABI < 0.9. However, there was a trend to a lower ABI and a higher prevalence of ABI < 0.9 with increasing ED severity. CONCLUSION: In the general population, the presence of ED identifies subjects with higher atherosclerosis burden in carotid arteries but not in the lower extremities.

Carotid atherosclerosis severity in relation to glycemic status: a cross-sectional population study.

OBJECTIVE: Intima-media thickness (IMT) is increased in subjects with prediabetes or newly diagnosed diabetes. However, no previous studies have evaluated the relationship between the severity of carotid atherosclerosis, assessed by the presence of carotid plaques or stenosis, and the glycemic status, assessed either by fasting glucose, an oral glucose tolerance test (OGTT) or A1C levels. METHODS: Cross-sectional analysis of 1475 subjects (mean age 62 years, 44% males), randomly selected from the population. A fasting blood sample was obtained to determine glucose, lipids, and A1C levels. An OGTT was performed in non-diabetic subjects. Carotid atherosclerosis was evaluated by echo-doppler. RESULTS: A 10.5% of the population had a previous diagnosis of diabetes. Of the 1320 non-diabetic participants, 349 (26.4%) had normal fasting glucose, normal glucose tolerance and A1C < 5.7%, and were considered controls. Prediabetes was diagnosed in 850 subjects (64.4%), and diabetes was newly diagnosed in 121 (9.2%). The prevalence of patients with carotid plaques was 34.2% in controls, 45.1% in prediabetics, 64.2% in newly diagnosed diabetics, and 72.9% in established diabetic patients. These numbers were 0.3%, 1.1%, 5.0% and 7.7% for carotid stenosis, respectively. In multivariate analysis, glycemic status remained significantly associated with the prevalence of carotid plaques after adjusting for age, sex, statin treatment, and cardiovascular risk factors. CONCLUSIONS: Glycemic status is associated with all grades of carotid atherosclerosis, from early signs, as demonstrated by the IMT, to intermediate degrees, as demonstrated by the presence of carotid plaques, to advance atherosclerosis, as established by the presence of carotid stenosis.

Validating prediction scales of type 2 diabetes mellitus in Spain: the SPREDIA-2 population-based prospective cohort study protocol.

INTRODUCTION: The incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide. When diagnosed, many patients already have organ damage or advance subclinical atherosclerosis. An early diagnosis could allow the implementation of lifestyle changes and treatment options aimed at delaying the progression of the disease and to avoid cardiovascular complications. Different scores for identifying undiagnosed diabetes have been reported, however, their performance in populations of southern Europe has not been sufficiently evaluated. The main objectives of our study are: to evaluate the screening performance and cut-off points of the main scores that identify the risk of undiagnosed T2DM and prediabetes in a Spanish population, and to develop and validate our own predictive models of undiagnosed T2DM (screening model), and future T2DM (prediction risk model) after 5-year follow-up. As a secondary objective, we will evaluate the atherosclerotic burden of the population with undiagnosed T2DM. METHODS AND ANALYSIS: Population-based prospective cohort study with baseline screening, to evaluate the performance of the FINDRISC, DANISH, DESIR, ARIC and QDScore, against the gold standard tests: Fasting plasma glucose, oral glucose tolerance and/or HbA1c. The sample size will include 1352 participants between the ages of 45 and 74 years. ANALYSIS: sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio positive, likelihood ratio negative and receiver operating characteristic curves and area under curve. Binary logistic regression for the first 700 individuals (derivation) and last 652 (validation) will be performed. All analyses will be calculated with their 95% CI; statistical significance will be p<0.05. ETHICS AND DISSEMINATION: The study protocol has been approved by the Research Ethics Committee of the Carlos III Hospital (Madrid). The score performance and predictive model will be presented in medical conferences, workshops, seminars and round table discussions. Furthermore, the predictive model will be published in a peer-reviewed medical journal to further increase the exposure of the scores.

Modificaciones en la activación y la expresión de moléculas de adhesión y receptores celulares monocitarios en pacientes hipercolesterolémicos tratados con pravastatina / Changes in the activation and expression of monocyte adhesion molecules and receptors in hypercholesterolemic patients treated with pravastatin

Introducción. Numerosos estudios han demostrado que las estatinas reducen la mortalidad cardiovascular. Si bien la mayor parte del efecto es probablemente debido a su acción hipolipemiante, se han descrito otras acciones de estos fármacos, independientes de la reducción del colesterol, que podrían contribuir a este efecto beneficioso. El objetivo del presente estudio fue evaluar el efecto del tratamiento con estatinas sobre la expresión de moléculas de adhesión, citocinas y receptores celulares de monocitos de sangre periférica, células estrechamente ligadas al desarrollo de la arteriosclerosis. Pacientes y métodos. Se seleccionó a 22 pacientes con hipercolesterolemia moderada (59% mujeres, edad media 51 años). Tras seguir durante 6 semanas una dieta baja en grasas, se aleatorizaron a recibir 40 mg/día de pravastatina o placebo durante 8 semanas, tras lo cual recibieron durante otras 8 semanas el tratamiento contrario. Resultados. El tratamiento con pravastatina redujo de manera significativa, respecto al período placebo, la concentración de colesterol total (22%; p < 0,01) y el colesterol unido a lipoproteínas de baja densidad (30%; p < 0,01). La expresión intracitoplasmática monocitaria del factor de necrosis tumoral alfa (TNFα) se redujo en un 17,3% (p = 0,03). No se observaron modificaciones en la expresión de CD62L, CD162, CD11a, CD11b, CD49d, CD54, MCP-1 y CCR2. Conclusión. El tratamiento con pravastatina durante 8 semanas en pacientes con hipercolesterolemia moderada induce un descenso en la intensidad media de fluorescencia con la que los monocitos de sangre periférica expresan TNFα, sin modificar la expresión de otras moléculas de adhesión (AU)

Introduction. Numerous studies have shown that statins reduce cardiovascular mortality. While most of the effect is probably due to their lipid-lowering action, other actions of these drugs, independent of cholesterol reduction, have been described that could influence these beneficial action. The aim of this study was to evaluate the effect of statins on the expression of adhesion molecules, cytokines and receptors of peripheral blood monocytes, cells closely linked to development of atherosclerosis. Patients and methods. We selected 22 patients with moderate hypercholesterolemia (59% female, mean age 51 years). After 6 weeks of a low fat they were randomized to receive 40 mg of pravastatin or placebo for 8 weeks. After that period they received for another 8 weeks the other treatment. Results. Treatment with pravastatin significantly reduced the concentration of total cholesterol (22%; p < 0.01) and LDL-cholesterol (30%; p < 0.01). Monocytic intracytoplasmic expression of TNFα was reduced by 17.3% (p = 0,03). Other cellular markers, CD62L, CD162, CD11a, CD11b, CD49d, CD54, MCP-1 and CCR2, did not change their expression Conclusion. Treatment with pravastatin for 8 weeks in patients with moderate hypercholesterolemia induces a decline in the average intensity of fluorescence with which peripheral blood monocytes express TNFα without changing the expression of other adhesion molecules (AU)

Relationship between ankle-brachial index and chronic kidney disease in hypertensive patients with no known cardiovascular disease.

Both decreased GFR and albuminuria are associated with an elevated prevalence of peripheral artery disease. However, the combined effects of these alterations previously were not evaluated. Patients with hypertension and with no known vascular disease (n = 955; mean age 66 yr; 56% male) were selected from internal medicine outpatient clinics throughout Spain. Cardiovascular risk factors, urinary albumin excretion, and the ankle-brachial index (ABI) were assessed in all participants. GFR was estimated according to the Cockroft-Gault equation. Of the study population, 62% had diabetes, 23.8% had a GFR <60 ml/min per 1.73 m2, and 43.8% had albuminuria. The prevalence of ABI <0.9 was greater in patients with a GFR <60 ml/min per 1.73 m2 (37.4 versus 24.3%; P < 0.0001) and in those who had albuminuria (32.2 versus 23.3%; P = 0.001). In patients with both alterations, the prevalence of ABI <0.9 was 45.7%. Multivariate analysis indicated that the factors that were associated independently with low ABI were age (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.03 to 1.08; P < 0.0001), triglyceride concentration (OR 1.003; 95% CI 1.001 to 1.005; P = 0.001), presence of albuminuria (OR 1.61; 95% CI 1.18 to 2.20; P = 0.003), smoking habit (OR 1.72; 95% CI 1.13 to 2.63; P = 0.012), and a GFR <60 ml/min per 1.73 m2 (OR 1.47; 95% CI 1.01 to 2.17; P = 0.049). In patients with hypertension and without known vascular disease, reduced GFR and albuminuria are associated independently with an ABI <0.9. Their combined presence characterizes a subgroup of the population who have an elevated prevalence of peripheral artery disease and could benefit from early diagnosis and treatment.

[Prevalence of an abnormal ankle-brachial index in relation to the cardiovascular risk estimated by the Framingham function]. / Prevalencia de un índice tobillo-brazo patológico según el riesgo cardiovascular calculado mediante la función de Framingham.

BACKGROUND AND OBJECTIVE: The measurement of the ankle-brachial index (ABI) is a straightforward method for the detection of atherosclerosis in the lower limbs. An abnormal ABI (< 0.9 or > 1.4) is associated with the development of cardiovascular disease and cardiovascular and all-cause mortality. Despite this, its measurement in clinical practice is underused. The objective of the present study was to evaluate the relation of the ABI with the cardiovascular risk determined by traditional risk functions in a population in primary prevention. PATIENTS AND METHOD: 1001 subjects without known cardiovascular disease attended in primary care were invited to participate in the study. Cardiovascular risk and ABI measurements were calculated in all participants. RESULTS: A low (< 0.9) ABI was found in a 3.8% of the participants, 3.9% females and 3.6% males. An abnormal ABI (< 0.9 or > 1.4) was found in 6.4% of all subjects, 5.2% females and 8.8% males. In a multivariable analysis age (OR = 1.09 for each year; 95% CI 1.03-1.15), smoking habit (OR = 2.96; 95% CI 1.51-5.80), HDL-cholesterol levels (OR = 0.98 for each mg/dl; 95% CI, 0.95-0.99) and hypertension (OR = 1.80; 95% CI, 1.05-3.06) were related with an abnormal ABI. Subjects were divided according to their risk stratification. The percentage of low, moderate and high risk individuals with an abnormal ABI was 2.6%, 8.7% and 14.9% respectively. CONCLUSIONS: In primary prevention, one in ten individuals with moderate risk and one in six individuals with high risk have an abnormal ABI. In these subjects there is an indication for intensive preventive strategies and antiagregation.

Prevalencia de un índice tobillo-brazo patológico según el riesgo cardiovascular calculado mediante la función de Framingham / Prevalence of an abnormal ankle-brachial index in relation to the cardiovascular risk estimated by the Framingham function

FUNDAMENTO Y OBJETIVO: La medición del índice tobillo-brazo (ITB) es un método sencillo para detectar la presencia de arteriosclerosis en miembros inferiores. Un valor inferior a 0,9 o superiora 1,4 se asocia con un riesgo elevado de enfermedad cardiovascular, cerebrovascular y/o muerte por cualquier causa. A pesar de ello, su implantación en la práctica clínica es escasa. El objetivo del presente estudio fue determinar la prevalencia de un ITB patológico en una población en prevención primaria clasificada según su riesgo vascular calculado por la función de Framingham recomendada por el National Cholesterol Education Program en su documento Adult Treatment Panel III. PACIENTES Y MÉTODO: Participaron en el estudio 1.001 sujetos sin enfermedad vascular conocida atendidos en atención primaria. A todos ellos se les estimó el riesgo vascular y se les midió el ITB. RESULTADOS: El ITB fue bajo (menor de 0,9) en un 3,8% de los participantes (un 3,9% de las mujeres y un 3,6% de los varones). Se consideró patológico (inferior a 0,9 o mayor de 1,4) en un 6,4% (un 5,2% de las mujeres y un 8,8% de los varones). En el análisis multivariante los factores que se asociaron con un ITB patológico fueron la edad odds ratio (OR) = 1,09 porcada año de edad; intervalo de confianza (IC) del 95%, 1,03-1,15), el tabaquismo (OR = 2,96;IC del 95%, 1,51-5,80), la concentración de colesterol unido a lipoproteínas de alta densidad(OR = 0,98 por cada mg/dl; IC del 95%, 0,95-0,99) y la presencia de hipertensión arterial (OR =1,80; IC del 95%, 1,05-3,06). Al ser clasificados según su riesgo vascular, el porcentaje de sujetos de riesgo bajo, intermedio y alto con un ITB patológico fue del 2,6, el 8,7 y el 14,9%,respectivamente. CONCLUSIONES: En prevención primaria, uno de cada 10 sujetos con riesgo intermedio y uno década 6 con riesgo elevado presentan un ITB patológico. En estos sujetos están indicadas lasmedidas preventivas enérgicas y la antiagregación

BACKGROUND AND OBJECTIVE: The measurement of the ankle-brachial index (ABI) is a straight forward method for the detection of atherosclerosis in the lower limbs. An abnormal ABI ( 1.4) is associated with the development of cardiovascular disease and cardiovascular and all cause mortality. Despite this, its measurement in clinical practice is underused. The objective of the present study was to evaluate the relation of the ABI with the cardiovascular risk determined by traditional risk functions in a population in primary prevention. PATIENTS AND METHOD: 1001 subjects without known cardiovascular disease attended in primary care were invited to participate in the study. Cardiovascular risk and ABI measurements were calculated in all participants. RESULTS: A low ( 1.4) was found in 6.4% of all subjects, 5.2% females and8.8% males. In a multivariable analysis age (OR = 1.09 for each year; 95% CI 1.03-1.15),smoking habit (OR = 2.96; 95% CI 1.51-5.80), HDL-cholesterol levels (OR = 0.98 for each mg/dl; 95% CI, 0.95-0.99) and hypertension (OR = 1.80; 95% CI, 1.05-3.06) were related with an abnormal ABI. Subjects were divided according to their risk stratification. The percentage of low, moderate and high risk individuals with an abnormal ABI was 2.6%, 8.7% and14.9% respectively. CONCLUSIONS: In primary prevention, one in ten individuals with moderate risk and one in six individuals with high risk have an abnormal ABI. In these subjects there is an indication for intensive preventive strategies and antiagregation

[The application of the SCORE charts to advanced age males triple the number of high-risk subjects compared to the Framingham function]. / La aplicación de las tablas del SCORE a varones de edad avanzada triplica el número de sujetos clasificados de alto riesgo en comparación con la función de Framingham.

BACKGROUND AND OBJECTIVE: The Framingham function, recommended by the National Cholesterol Education Program in its document Adult Treatment Panel III (ATP III), and the risk charts of the Systematic Coronary Risk Evaluation (SCORE) program are the most used functions for risk stratification. In both, intensive hygienic and therapeutic measures are recommended for high risk individuals. The objective of the present study was to compare the risk stratification obtained with both functions in a population of subjects older than 60 years. SUBJECTS AND METHOD: 1001 non-diabetic subjects between 60 and 79 years old (mean: 69 years, 67% female) with no evidence of cardiovascular disease were included in the study. Participants were classified as low, moderate or high risk by ATP-III (< 10%, 10-20% y > 20% of risk at 10 years, respectively) and by SCORE (< 3%, 3-4% y > or = 5% of risk at 10 years respectively). RESULTS: 11.7% of the population was classified as high risk by Framingham and 17.6% by SCORE. Only 5% of the females were classified as high risk with either function. In males, 16.7% and a 44.4% were classified as high risk by Framingham and SCORE respectively. The results did not differ by age group. A 39% of males and a 20% of females were candidates to hypolipidemic treatment as recommended by SCORE guidelines. CONCLUSIONS: Compared to Framingham function, the application of SCORE charts to spanish males over 60 years triplicate the number of high risk individuals and candidates to intensive risk factor treatment.

La aplicación de las tablas del SCORE a varones de edad avanzada triplica el número de sujetos clasificados de alto riesgo en comparación con la función de Framingham / The application of the SCORE charts to advanced age males triple the number of high-risk subjects compared to the Framingham function

FUNDAMENTO Y OBJETIVO: La función de Framingham, recomendada por el National Cholesterol Education Program en su documento Adult Treatment Panel III (ATP-III) y las tablas de riesgodel Systematic Coronary Risk Evaluation (SCORE) son las funciones más utilizadas para la estratificación del riesgo cardiovascular, y ambas recomiendan intensificar las medidas higiénicas y terapéuticas en las personas que presenten un riesgo alto. El objetivo del presente estudio fue comparar la estratificación del riesgo obtenida con ambas clasificaciones en una población de sujetos mayores de 60 años. SUJETOS Y MÉTODO: Se incluyó en el estudio a 1.001 personas no diabéticas de entre de 60 y 79años (media de 69 años, un 67%, mujeres) sin evidencia de enfermedad vascular. Se clasificó a los participantes según su riesgo fuera bajo, medio o alto de acuerdo con el ATP-III ( 20% de riesgo a los 10 años, respectivamente) y el SCORE (< 3%, 3-4% y ≥ 5%de riesgo a los 10 años, respectivamente).RESULTADOS: Un 11,7% de la población se consideró de riesgo alto según la ecuación de Framingham,f rente a un 17,6% según el SCORE. Únicamente un 5% de las mujeres fueron clasificadas de riesgo alto con cualquiera de las funciones, frente a un 16,7 y un 44,4% de los varones según las tablas de Framingham y de SCORE, respectivamente. Los resultados fueron similares al dividir por grupos de edad. De acuerdo con las guías del SCORE, un 39% de los varones y un 20% de las mujeres eran candidatos a recibir tratamiento hipolipemiante. CONCLUSIONES: En comparación con la función de Framingham, la aplicación del SCORE en varones mayores de 60 años triplica el número de sujetos de alto riesgo candidatos a medidas de prevención enérgicas

BACKGROUND AND OBJECTIVE: The Framingham function, recommended by the National Choresterol Education Program in its document Adult Treatment Panel III (ATP III), and the risk charts ofthe Systematic Coronary Risk Evaluation (SCORE) program are the most used functions for risk stratification. In both, intensive hygienic and therapeutic measures are recommended for high risk individuals. The objective of the present study was to compare the risk stratification obtained with both functions in a population of subjects older than 60 years. SUBJECTS AND METHOD: 1001 non-diabetic subjects between 60 and 79 years old (mean: 69 years,67% female) with no evidence of cardiovascular disease were included in the study. Participants were classified as low, moderate or high risk by ATP-III ( 20% of risk at 10 years, respectively) and by SCORE (< 3%, 3-4% y ≥ 5% of risk at 10 years respectively).RESULTS: 11.7% of the population was classified as high risk by Framingham and 17.6% by SCORE. Only 5% of the females were classified as high risk with either function. In males,16.7% and a 44.4% were classified as high risk by Framingham and SCORE respectively. The results did not differ by age group. A 39% of males and a 20% of females were candidates tohypolipidemic treatment as recommended by SCORE guidelines. CONCLUSIONS: Compared to Framingham function, the application of SCORE charts to Spanish males over 60 years triplicate the number of high risk individuals and candidates to intensive risk factor treatment