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1.
Kardiologiia ; 60(7): 103-107, 2020 Aug 11.
Artículo en Ruso | MEDLINE | ID: mdl-33155948

RESUMEN

The article discusses issues of lipid-lowering therapy in elderly and senile patients. Major statements of actual clinical guidelines are provided. Issues of statin therapy in patients older than 65 and new data on statin safety in such patients are discussed in detail. The authors presented results of clinical studies 2019 on the use of ezetimibe in patients older than 75 as a part of primary and secondary prevention of cardiovascular diseases.


Asunto(s)
Anticolesterolemiantes , Enfermedades Cardiovasculares , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Anciano , Anticolesterolemiantes/efectos adversos , Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedades Cardiovasculares/prevención & control , Quimioterapia Combinada , Ezetimiba/uso terapéutico , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Lípidos , Prevención Secundaria
2.
Kardiologiia ; 60(8): 71-77, 2020 Sep 17.
Artículo en Ruso | MEDLINE | ID: mdl-33155961

RESUMEN

Aim To study the efficacy and safety of alirocumab in patients with high and very high cardiovascular risk in the Republic of Karelia and to evaluate their compliance with the alirocumab therapy.Materials and methods Study design: observational, noncomparative. The observation group consisted of 9 patients receiving alirocumab (Praluent®) (mean age, 48.6±4.7 years; 7 men). 7 patients had familial hypercholesterolemia of the type diagnosed by DLCN criteria; five patients had MI. Lipid profile, concentrations of transaminases, creatinine, glucose, and lipoprotein a (LP(a)) were measured at 3, 6, 12, and 18 months. Electrocardiography was performed, and the clinical picture (development of acute coronary syndrome, acute cerebrovascular disease, transient ischemic attacks, myocardial revascularization, and cardiovascular death) was evaluated. Efficacy criteria included the absence of these clinical conditions, the proportion of patients who achieved the LDL CS goal, and the decrease in LP(a). Safety was evaluated by clinical and laboratory data, such as levels of transaminases, total bilirubin, creatinine, and blood glucose. The observation lasted for 6 months to 1.5 years.Results LDL CS goals were achieved in 7 (77.8%) patients receiving alirocumab. The mean level of LP(a) decreased from 0.39 to 0.28 g/l; the degree of decrease ranged from 20 to 33 %. No cases of IHD instability (acute coronary syndrome) or new cases of acute cerebrovascular disease and transient ischemic attacks were observed. None of the patients had to stop the alirocumab treatment; adverse effects, including local ones, were not observed.Conclusion LDL CS goals were achieved in 7 (77.8%) patients. The level of LP(a) decreased by 20-33% in patients receiving the PCSK9 inhibitor. In real-life clinical practice, the alirocumab treatment was characterized with high compliance and good tolerability without side effects, including local ones.


Asunto(s)
Anticolesterolemiantes , Enfermedades Cardiovasculares , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Hipercolesterolemia , Adulto , Anticuerpos Monoclonales Humanizados , Anticolesterolemiantes/efectos adversos , Enfermedades Cardiovasculares/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Proproteína Convertasa 9 , Factores de Riesgo , Resultado del Tratamiento
3.
Kardiologiia ; 60(9): 122-133, 2020 Oct 14.
Artículo en Ruso | MEDLINE | ID: mdl-33131483

RESUMEN

Cardiovascular diseases remain a leading cause for unfavorable outcomes, including death, in patients with type 2 diabetes mellitus (DM2). In the recent decade, novel drugs, including glucagon-like peptide-1 receptor agonists (GPP-1-RA) and sodium-glucose cotransporter-2 inhibitors, have convincingly demonstrated their ability to reduce risk of cardiovascular complications in patients with DM2. This review discusses one of GPP-1-RA, semaglutide, with a special focus on the evidence-based data on its use, cardioprotective properties, and algorithms of administration consistent with current clinical recommendations.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Receptor del Péptido 1 Similar al Glucagón , Péptidos Similares al Glucagón , Humanos , Hipoglucemiantes
5.
JAMA ; 324(18): 1884-1895, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33170247

RESUMEN

Importance: Childhood hypertension can result in adverse outcomes during adulthood; identifying and treating primary and secondary childhood hypertension may reduce such risks. Objective: To update the evidence on screening and treatment of hypertension in childhood and adolescence for the US Preventive Services Task Force. Data Sources: PubMed, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, and trial registries through September 3, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through October 6, 2020. Study Selection: Fair- or good-quality English-language studies evaluating diagnostic accuracy of blood pressure screening; cohort studies assessing the association of hypertension in childhood and adolescence with blood pressure or other intermediate outcomes in adulthood; randomized clinical trials (RCTs) or meta-analyses of pharmacological and lifestyle interventions. Data Extraction and Synthesis: Two reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; the evidence was synthesized qualitatively. Main Outcomes and Measures: Sensitivity, specificity, and measures of association between childhood and adulthood blood pressure; reduction of childhood blood pressure; adverse effects of treatments. Results: Forty-two studies from 43 publications were included (N>12 400). No studies evaluated the benefits or harms of screening and the effect of treating childhood hypertension on outcomes in adulthood. One study reported a sensitivity of 0.82 and a specificity of 0.70 for 2 office-based blood pressure measurements. Twenty observational studies suggested a significant association between childhood hypertension and abnormal blood pressure in adulthood (odds ratios, 1.1-4.5; risk ratios, 1.45-3.60; hazard ratios, 2.8-3.2). Thirteen placebo-controlled RCTs and 1 meta-analysis assessed reductions in systolic (SBP) and diastolic blood pressure from pharmacological treatments. Pooled reductions of SBP were -4.38 mm Hg (95% CI, -7.27 to -2.16) for angiotensin-converting enzyme inhibitors and -3.07 mm Hg (95% CI, -4.99 to -1.44) for angiotensin receptor blockers. Candesartan reduced SBP by -6.56 mm Hg (P < .001; n = 240). ß-Blockers, calcium channel blockers, and mineralocorticoid receptor antagonists did not achieve significant reductions over 2 to 4 weeks. SBP was significantly reduced by exercise over 8 months (-4.9 mm Hg, P ≤ .05; n = 69), by dietary approaches to stop hypertension over 3 months (-2.2 mm Hg, P < .01; n = 57), and by a combination of drug treatment and lifestyle interventions over 6 months (-7.6 mm Hg; P < .001; n = 95). Low-salt diet did not achieve reductions of blood pressure. Conclusions and Relevance: Observational studies indicate an association between hypertension in childhood and hypertension in adulthood. However, the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care.


Asunto(s)
Hipertensión/diagnóstico , Tamizaje Masivo , Adolescente , Adulto , Antihipertensivos/efectos adversos , Antihipertensivos/uso terapéutico , Determinación de la Presión Sanguínea/instrumentación , Enfermedades Cardiovasculares/prevención & control , Niño , Preescolar , Terapia Combinada , Dieta Saludable , Ejercicio Físico , Femenino , Humanos , Hipertensión/terapia , Masculino , Tamizaje Masivo/efectos adversos , Tamizaje Masivo/psicología , Estudios Observacionales como Asunto , Guías de Práctica Clínica como Asunto , Servicios Preventivos de Salud , Sensibilidad y Especificidad
6.
JAMA ; 324(18): 1878-1883, 2020 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-33170248

RESUMEN

Importance: Prevalence of hypertension (both primary and secondary) in children and adolescents in the US ranges from 3% to 4%. Primary hypertension in children and adolescents occurs primarily in children older than 13 years and has no known cause but is associated with several risk factors, including family history and higher body mass index. Secondary hypertension occurs primarily in younger children and is most commonly caused by genetic disorders, renal disease, endocrine disorders, or cardiovascular abnormalities. Objective: To update its 2013 recommendation, the USPSTF commissioned a review of the evidence on the benefits and harms of screening, test accuracy, the effectiveness and harms of treatment, and the association between hypertension and markers of cardiovascular disease in childhood and adulthood. Population: This recommendation statement applies to children and adolescents aged 3 to 18 years not known to have hypertension or who are asymptomatic. Evidence Assessment: The USPSTF concludes that the evidence to support screening for high blood pressure in children and adolescents is insufficient and that the balance of benefits and harms cannot be determined. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for high blood pressure in children and adolescents. (I statement).


Asunto(s)
Hipertensión/diagnóstico , Tamizaje Masivo , Adolescente , Determinación de la Presión Sanguínea/instrumentación , Enfermedades Cardiovasculares/prevención & control , Niño , Preescolar , Reacciones Falso Positivas , Femenino , Humanos , Hipertensión/terapia , Masculino , Tamizaje Masivo/efectos adversos , Servicios Preventivos de Salud , Valores de Referencia
7.
Vasc Health Risk Manag ; 16: 403-418, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33116551

RESUMEN

Cardiovascular (CV) disease remains the leading cause of morbidity and mortality worldwide and poses an ongoing challenge with the aging population. Elevated low-density lipoprotein cholesterol (LDL-C) is an established risk factor for atherosclerotic cardiovascular disease (ASCVD), and the expert consensus is the use of statin therapy (if tolerated) as first line for LDL-C reduction. However, patients with ASCVD may experience recurrent ischemic events despite receiving maximally tolerated statin therapy, including those whose on-treatment LDL-C remains ≥70 mg/dL, patients with familial hypercholesterolemia, high-risk subgroups with comorbidities such as diabetes mellitus, and those who have an intolerance to statin therapy. Optimal therapeutic strategies for this unmet need should deploy aggressive lipid lowering to minimize the contribution of dyslipidemia to their CV risk, particularly for very high-risk populations with additional risk factors beyond hypercholesterolemia and established ASCVD. To understand the current clinical climate and guidelines regarding ASCVD, we primarily searched PubMed for articles published in English regarding lipid-lowering therapies and CV risk reduction, including emerging therapies, and CV outcomes trials with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. This review discusses the findings of recent clinical trial evidence for CV risk reduction with cholesterol-lowering therapies, with a focus on CV outcomes trials with PCSK9 inhibitors, and considers the impact of the study results for secondary prevention and future strategies in patients with hypercholesterolemia and CV risk despite maximally tolerated statin therapy.


Asunto(s)
Anticolesterolemiantes/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , LDL-Colesterol/sangre , Dislipidemias/tratamiento farmacológico , Proproteína Convertasa 9/antagonistas & inhibidores , Inhibidores de Serina Proteinasa/uso terapéutico , Anticolesterolemiantes/efectos adversos , Biomarcadores/sangre , Enfermedades Cardiovasculares/epidemiología , Quimioterapia Combinada , Dislipidemias/sangre , Dislipidemias/epidemiología , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Factores de Riesgo , Inhibidores de Serina Proteinasa/efectos adversos , Resultado del Tratamiento
8.
Arch Cardiovasc Dis ; 113(10): 590-598, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33011157

RESUMEN

BACKGROUND: Cardiovascular diseases are a leading cause of mortality, but a substantial proportion are preventable. AIMS: The Mutuelle générale de l'éducation nationale (MGEN), a provider of private health insurance in France, has developed the VIVOPTIM programme, a novel digital approach to healthcare based on individualized, multiprofessional, ranked management of cardiovascular risk factors. METHODS: Between November 2015 and June 2016, eligible individuals (age 30-70 years) from two regions of France were invited to participate. Volunteers completed a questionnaire based on the Framingham Heart Study Risk Score and were assigned to one of three cardiovascular risk levels. VIVOPTIM comprises four components: cardiovascular risk assessment, instruction on cardiovascular diseases and associated risk factors, personalized coaching (telephone sessions with a specially trained healthcare professional to provide information on risk factors and disease management, set individual health targets, monitor progress and motivate participants), and e-Health monitoring. RESULTS: Data from 2240 participants were analysed. Significant benefits were observed on mean systolic blood pressure (-3.4mmHg), weight (-1.5kg), smoking (-2.2 cigarettes/day) and daily steps (+1726 steps/day (all P<0.0001)), though not on weekly duration of exercise (-0.2hours/week, P=0.619). CONCLUSION: As a result of the positive mid-to-long-term results of the pilot programme on weight, smoking, blood pressure, and uptake of physical activity, the VIVOPTIM programme was extend to the whole of France in 2018 and has the potential to have a genuine impact on patient care and organization of the healthcare system in France.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Estilo de Vida Saludable , Educación del Paciente como Asunto , Prevención Primaria , Telemedicina , Adulto , Anciano , Presión Sanguínea , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/etiología , Dieta Saludable , Ejercicio Físico , Femenino , Francia , Conocimientos, Actitudes y Práctica en Salud , Estado de Salud , Humanos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Medición de Riesgo , Factores de Riesgo , Cese del Hábito de Fumar , Pérdida de Peso
9.
Cochrane Database Syst Rev ; 10: CD011748, 2020 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-33078867

RESUMEN

BACKGROUND: Despite the availability of effective drug therapies that reduce low-density lipoprotein (LDL)-cholesterol (LDL-C), cardiovascular disease (CVD) remains an important cause of mortality and morbidity. Therefore, additional LDL-C reduction may be warranted, especially for people who are unresponsive to, or unable to take, existing LDL-C-reducing therapies. By inhibiting the proprotein convertase subtilisin/kexin type 9 (PCSK9) enzyme, monoclonal antibodies (PCSK9 inhibitors) reduce LDL-C and CVD risk. OBJECTIVES: Primary To quantify the effects of PCSK9 inhibitors on CVD, all-cause mortality, myocardial infarction, and stroke, compared to placebo or active treatment(s) for primary and secondary prevention. Secondary To quantify the safety of PCSK9 inhibitors, with specific focus on the incidence of influenza, hypertension, type 2 diabetes, and cancer, compared to placebo or active treatment(s) for primary and secondary prevention. SEARCH METHODS: We identified studies by systematically searching CENTRAL, MEDLINE, Embase, and Web of Science in December 2019. We also searched ClinicalTrials.gov and the International Clinical Trials Registry Platform in August 2020 and screened the reference lists of included studies. This is an update of the review first published in 2017. SELECTION CRITERIA: All parallel-group and factorial randomised controlled trials (RCTs) with a follow-up of at least 24 weeks were eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed and extracted data. Where data were available, we calculated pooled effect estimates. We used GRADE to assess certainty of evidence and in 'Summary of findings' tables. MAIN RESULTS: We included 24 studies with data on 60,997 participants. Eighteen trials randomised participants to alirocumab and six to evolocumab. All participants received background lipid-lowering treatment or lifestyle counselling. Six alirocumab studies used  an active treatment comparison group (the remaining used placebo), compared to three evolocumab active comparison trials. Alirocumab compared with placebo decreased the risk of CVD events, with an absolute risk difference (RD) of -2% (odds ratio (OR) 0.87, 95% confidence interval (CI) 0.80 to 0.94; 10 studies, 23,868 participants; high-certainty evidence), decreased the risk of mortality (RD -1%; OR 0.83, 95% CI 0.72 to 0.96; 12 studies, 24,797 participants; high-certainty evidence), and MI (RD -2%; OR 0.86, 95% CI 0.79 to 0.94; 9 studies, 23,352 participants; high-certainty evidence) and for any stroke (RD 0%; OR 0.73, 95% CI 0.58 to 0.91; 8 studies, 22,835 participants; high-certainty evidence). Compared to active treatment the alirocumab effects, for CVD, the RD was 1% (OR 1.37, 95% CI 0.65 to 2.87; 3 studies, 1379 participants; low-certainty evidence); for mortality, RD was -1% (OR 0.51, 95% CI 0.18 to 1.40; 5 studies, 1333 participants; low-certainty evidence); for MI, RD was 1% (OR 1.45, 95% CI 0.64 to 3.28, 5 studies, 1734 participants; low-certainty evidence); and for any stroke, RD was less than 1% (OR 0.85, 95% CI 0.13 to 5.61; 5 studies, 1734 participants; low-certainty evidence). Compared to placebo the evolocumab, for CVD, the RD was -2% (OR 0.84, 95% CI 0.78 to 0.91; 3 studies, 29,432 participants; high-certainty evidence); for mortality, RD was less than 1% (OR 1.04, 95% CI 0.91 to 1.19; 3 studies, 29,432 participants; high-certainty evidence); for MI, RD was -1% (OR 0.72, 95% CI 0.64 to 0.82; 3 studies, 29,432 participants; high-certainty evidence); and for any stroke RD was less than -1% (OR 0.79, 95% CI 0.65 to 0.94; 2 studies, 28,531 participants; high-certainty evidence).  Compared to active treatment, the evolocumab effects, for any CVD event RD was less than -1% (OR 0.66, 95% CI 0.14 to 3.04; 1 study, 218 participants; very low-certainty evidence); for all-cause mortality, the RD was less than 1% (OR 0.43, 95% CI 0.14 to 1.30; 3 studies, 5223 participants; very low-certainty evidence); and for MI, RD was less than 1% (OR 0.66, 95% CI 0.23 to 1.85; 3 studies, 5003 participants; very low-certainty evidence). There were insufficient data on any stroke.  AUTHORS' CONCLUSIONS: The evidence for the clinical endpoint effects of  evolocumab and alirocumab were graded as high. There is a strong evidence base to prescribe PCSK9 monoclonal antibodies to people who might not be eligible for other lipid-lowering drugs, or to people who cannot meet their lipid goals on more traditional therapies, which was the main patient population of the available trials.  The evidence base of PCSK9 inhibitors compared with active treatment is much weaker (low very- to low-certainty evidence) and it is unclear whether evolocumab or alirocumab might be effectively used as replacement therapies. Related, most of the available studies preferentially enrolled people with either established CVD or at a high risk already, and evidence in low- to medium-risk settings is minimal. Finally, there is very limited evidence on any potential safety issues of both evolocumab and alirocumab. While the current evidence synthesis does not reveal any adverse signals, neither does it provide evidence against such signals. This suggests careful consideration of alternative lipid lowering treatments before prescribing PCSK9 inhibitors.


Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , LDL-Colesterol/sangre , Proproteína Convertasa 9/antagonistas & inhibidores , Anticolesterolemiantes/uso terapéutico , Causas de Muerte , Antagonistas Colinérgicos/uso terapéutico , Ezetimiba/uso terapéutico , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Prevención Primaria/métodos , Proproteína Convertasa 9/inmunología , Ensayos Clínicos Controlados Aleatorios como Asunto , Prevención Secundaria/métodos , Accidente Cerebrovascular/epidemiología , Factores de Tiempo
10.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(9): 1428-1432, 2020 Sep 10.
Artículo en Chino | MEDLINE | ID: mdl-33076593

RESUMEN

Most cardiovascular disease (CVD) related risk factors are prevalent in children and adolescents, especially obesity, elevated blood pressure (BP) and increased unhealthy lifestyle. To prevent CVD in adulthood, it is necessary to attach importance to the prevention and control of CVD risk factors in childhood. Of note, the prevention of childhood obesity is key measure, the control of childhood BP is the first goal, and the development of healthy lifestyle is important basis. The prevention and control of CVD risk factors in childhood can benefit the future prevention and treatment of CVD in adulthood, provide scientific base for the prevention and intervention of cardiovascular risk factors in childhood, and provide new perspective for the early prevention of cardiovascular diseases in adulthood.


Asunto(s)
Enfermedades Cardiovasculares , Adolescente , Adulto , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Niño , Humanos , Hipertensión/epidemiología , Hipertensión/prevención & control , Estilo de Vida , Obesidad Pediátrica/epidemiología , Obesidad Pediátrica/prevención & control , Factores de Riesgo
11.
Rev Assoc Med Bras (1992) ; 66(9): 1283-1288, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33027459

RESUMEN

The pharmacological therapy for type 2 diabetes mellitus has presented important advances in recent years, which has impacted the treatment of patients with established cardiovascular disease or with high cardiovascular risk. In this scenario, two drug classes have emerged and demonstrated clear clinical benefits: SGLT-2 inhibitors and GLP-1 agonists. The present review discusses the pharmacology, adverse effects, and clinical trials that have demonstrated the benefits of these medications in reducing cardiovascular risk.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Factores de Riesgo , Inhibidores del Cotransportador de Sodio-Glucosa 2
12.
Curr Atheroscler Rep ; 22(12): 72, 2020 10 03.
Artículo en Inglés | MEDLINE | ID: mdl-33009957

RESUMEN

PURPOSE OF REVIEW: The review highlights selected studies related to cardiovascular disease (CVD) prevention that were presented at the 2020 European Society of Cardiology (ESC) Congress-The Digital Experience. RECENT FINDINGS: The studies reviewed include clinical trials on novel RNA interference-based lipid-lowering therapies AKCEA-APOCIII-LRx and vupanorsen (AKCEA-ANGPTL3-LRx); the EVAPORATE trial assessing the effects of icosapent ethyl on coronary plaque volume progression; the LoDoCo2 trial evaluating the efficacy of low-dose colchicine in cardiovascular disease risk reduction among patients with chronic coronary artery disease; as well as the EMPEROR-Reduced trial evaluating cardiovascular and renal outcomes with empagliflozin in patients with heart failure and reduced ejection fraction. In addition, we review the BPLTTC analysis on blood pressure treatment across blood pressure levels and CVD status and discuss findings from the BRACE CORONA study that examined continuing versus suspending angiotensin-converting enzyme inhibitor or angiotensin receptor blockers in patients on these antihypertensive medications who were hospitalized with COVID-19 infection. The studies presented at the 2020 digital ESC Congress highlight the continuing advancements in the field of CVD prevention.


Asunto(s)
Betacoronavirus/fisiología , Cardiología , Fármacos Cardiovasculares/farmacología , Enfermedades Cardiovasculares , Infecciones por Coronavirus , Reguladores del Metabolismo de Lípidos/farmacología , Pandemias , Neumonía Viral , Compuestos de Bencidrilo/farmacología , Cardiología/métodos , Cardiología/tendencias , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Ensayos Clínicos como Asunto , Congresos como Asunto , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Ácido Eicosapentaenoico/análogos & derivados , Ácido Eicosapentaenoico/farmacología , Europa (Continente) , Glucósidos/farmacología , Humanos , Oligonucleótidos/farmacología , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Sociedades Médicas , Telecomunicaciones
13.
N Z Med J ; 133(1523): 76-86, 2020 10 09.
Artículo en Inglés | MEDLINE | ID: mdl-33032305

RESUMEN

AIMS: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists are classes of medications shown to reduce cardiovascular events and slow decline in renal function in people with type 2 diabetes (T2DM). They are recommended for many people as second-line agents after metformin by the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD). PHARMAC have proposed criteria for funding in New Zealand. This clinical audit compares which patients would be eligible for treatment under each criterion. METHODS: This retrospective audit was conducted in December 2019 of all registered patients with T2DM at three general practices within the Wellington/Porirua region. Relevant data were extracted from the electronic health records to enable assessment of eligibility under PHARMAC and ADA/EASD criteria. RESULTS: Of the 23,517 patients enrolled, 1,160 had T2DM. Under PHARMAC criteria 399 (34.4%) patients would be eligible for funded access compared with 339 (27.2%) by the 2018 ADA/EASD criteria and 559 (48.2%) by the revised 2020 ADA/EASD criteria. Differences in eligibility relate to threshold of HbA1c and inclusion of microalbuminuria for treatment. CONCLUSION: The proposed PHARMAC criteria will give access to these important drugs to those people with T2DM who will likely benefit the most.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Hipoglucemiantes/uso terapéutico , Enfermedades Renales , Adulto , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Auditoría Clínica , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Enfermedades Renales/complicaciones , Enfermedades Renales/epidemiología , Enfermedades Renales/fisiopatología , Enfermedades Renales/prevención & control , Masculino , Nueva Zelanda , Estudios Retrospectivos , Adulto Joven
14.
J Am Coll Cardiol ; 76(15): 1777-1794, 2020 10 13.
Artículo en Inglés | MEDLINE | ID: mdl-33032740

RESUMEN

Viral respiratory infections are risk factors for cardiovascular disease (CVD). Underlying CVD is also associated with an increased risk of complications following viral respiratory infections, including increased morbidity, mortality, and health care utilization. Globally, these phenomena are observed with seasonal influenza and with the current coronavirus disease 2019 (COVID-19) pandemic. Persons with CVD represent an important target population for respiratory virus vaccines, with capacity developed within 3 large ongoing influenza vaccine cardiovascular outcomes trials to determine the potential cardioprotective effects of influenza vaccines. In the context of COVID-19, these international trial networks may be uniquely positioned to redeploy infrastructure to study therapies for primary and secondary prevention of COVID-19. Here, we describe mechanistic links between influenza and COVID-19 infection and the risk of acute cardiovascular events, summarize the data to date on the potential cardioprotective effects of influenza vaccines, and describe the ongoing influenza vaccine cardiovascular outcomes trials, highlighting important lessons learned that are applicable to COVID-19.


Asunto(s)
Enfermedades Cardiovasculares , Infecciones por Coronavirus , Vacunas contra la Influenza/farmacología , Gripe Humana , Pandemias , Neumonía Viral , Betacoronavirus , Cardiotónicos/farmacología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Ensayos Clínicos como Asunto , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Humanos , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Salud Pública , Factores de Riesgo , Vacunación/métodos
15.
BMJ ; 371: m3109, 2020 10 12.
Artículo en Inglés | MEDLINE | ID: mdl-33046451

RESUMEN

Hypertriglyceridemia is one of the most common lipid abnormalities encountered in clinical practice. Many monogenic disorders causing severe hypertriglyceridemia have been identified, but in most patients triglyceride elevations result from a combination of multiple genetic variations with small effects and environmental factors. Common secondary causes include obesity, uncontrolled diabetes, alcohol misuse, and various commonly used drugs. Correcting these factors and optimizing lifestyle choices, including dietary modification, is important before starting drug treatment. The goal of drug treatment is to reduce the risk of pancreatitis in patients with severe hypertriglyceridemia and cardiovascular disease in those with moderate hypertriglyceridemia. This review discusses the various genetic and acquired causes of hypertriglyceridemia, as well as current management strategies. Evidence supporting the different drug and non-drug approaches to treating hypertriglyceridemia is examined, and an easy to adopt step-by-step management strategy is presented.


Asunto(s)
Manejo de la Enfermedad , Hipertrigliceridemia/terapia , Adulto , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Femenino , Humanos , Hipertrigliceridemia/complicaciones , Hipertrigliceridemia/genética , Hipolipemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Pancreatitis/etiología , Pancreatitis/prevención & control , Factores de Riesgo , Triglicéridos/sangre
16.
Medicine (Baltimore) ; 99(41): e22660, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031329

RESUMEN

BACKGROUND: Dapagliflozin, a novel inhibitor of renal sodium-glucose cotransporter 2, allows an insulin-independent approach to improve type 2 diabetes hyperglycemia. This current research is a double blinded, randomized, and prospective trial to determine the effect of dapagliflozin on cardiovascular outcomes in type 2 diabetes. METHODS: This randomized controlled, double-blinded, single center trial is carried out according to the principles of Declaration of Helsinki. This present study was approved in institutional review committee of the Lianyungang Hospital affiliated to Xuzhou Medical University (LW-20200901001). All the patients received the informed consent. Diabetic patients were randomized equally to receive 28-week treatment with dapagliflozin or matching placebo. The major outcome of our current study was the change in the level of hemoglobin A1c (HbA1c) from the baseline to week 28. Secondary outcome measures contained the levels of fasting blood glucose, the mean change in seated systolic and diastolic blood pressure, body weight, and the mean change in calculated average daily insulin dose in patients treated with insulin at baseline, the other laboratory variables, and self-reported adverse events. The P < .05 was regarded as statistically significant. RESULTS: We assumed that the dapagliflozin administration in patients with type 2 diabetes would reduce HbA1c, body weight, systolic blood pressure, and achieve the goal of glycemic control, without adversely impacting cardiovascular risk. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5987).


Asunto(s)
Compuestos de Bencidrilo/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Glucósidos/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Enfermedades Cardiovasculares/etiología , Diabetes Mellitus Tipo 2/complicaciones , Método Doble Ciego , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto
17.
Cardiovasc J Afr ; 31(2): 103-110, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33094797

RESUMEN

Data collected by PASCAR for the World Heart Federation's Cardiovascular Diseases Scorecard project in Africa are presented. We summarise the strengths, threats, weaknesses and priorities identified from the collected data, which need to be considered in conjunction with the associated sections in the accompanying infographic. Data sets that were used include open-source data from the World Bank, World Health Organization and government publications.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Servicios Preventivos de Salud/organización & administración , Adolescente , Adulto , Anciano , Camerún/epidemiología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Comorbilidad , Prestación Integrada de Atención de Salud/organización & administración , Femenino , Accesibilidad a los Servicios de Salud/organización & administración , Estado de Salud , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Formulación de Políticas , Prevalencia , Pronóstico , Medición de Riesgo , Factores de Riesgo , Determinantes Sociales de la Salud , Participación de los Interesados , Adulto Joven
18.
Medicine (Baltimore) ; 99(43): e22952, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120856

RESUMEN

Pulmonary hypertension (PH) is a complication of multiple myeloma (MM); however, the clinical outcomes and prognosis are relatively not well known. We aimed to investigate the risk factors of transthoracic echocardiography-defined PH and its impact on the clinical outcome in patients with MM.A retrospective study was performed using data from the Chonnam National University Hwasun Hospital database for patients who underwent transthoracic echocardiography (TTE) within 1 month of the MM diagnosis between January 2007 and December 2017. PH was defined as an estimated right ventricular systolic pressure (RVSP) > 40 mmHg. A total of 390 patients were included. TTE-defined PH was observed in 107 patients (27%). During the follow-up period (median, 688 days), all-cause death was noted for 134 patients (34.4%). In the Kaplan-Meier survival analysis, the cumulative overall survival and cardiovascular death-free survival rates were significantly lower in the PH group than in the non-PH group (P < .001). In the propensity score-matched population, RVSP > 40 mmHg on TTE and history of congestive heart failure (CHF) were identified as the significant independent predictors of all-cause and cardiovascular death.This study reports that the prevalence of TTE-defined PH is higher in patients with MM than in the general population. Moreover, TTE-defined PH and a history of CHF are the independent prognostic factors for all-cause and cardiovascular death in patients with MM. These results highlight the risk of associated cardiovascular disease in patients with MM and emphasize the importance of management strategies that prevent the deterioration of cardiac function.


Asunto(s)
Ecocardiografía/métodos , Hipertensión Pulmonar/etiología , Mieloma Múltiple/complicaciones , Mieloma Múltiple/mortalidad , Anciano , Presión Sanguínea/fisiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Estudios de Casos y Controles , Manejo de Datos , Muerte , Ecocardiografía/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/epidemiología , Humanos , Hipertensión Pulmonar/diagnóstico por imagen , Hipertensión Pulmonar/fisiopatología , Masculino , Persona de Mediana Edad , Mieloma Múltiple/patología , Pronóstico , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Función Ventricular Derecha/fisiología
19.
JAMA ; 324(15): 1543-1556, 2020 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-33079159

RESUMEN

Importance: Down syndrome is the most common chromosomal condition, and average life expectancy has increased substantially, from 25 years in 1983 to 60 years in 2020. Despite the unique clinical comorbidities among adults with Down syndrome, there are no clinical guidelines for the care of these patients. Objective: To develop an evidence-based clinical practice guideline for adults with Down syndrome. Evidence Review: The Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup (n = 13) developed 10 Population/Intervention/ Comparison/Outcome (PICO) questions for adults with Down syndrome addressing multiple clinical areas including mental health (2 questions), dementia, screening or treatment of diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, thyroid disease, and celiac disease. These questions guided the literature search in MEDLINE, EMBASE, PubMed, PsychINFO, Cochrane Library, and the TRIP Database, searched from January 1, 2000, to February 26, 2018, with an updated search through August 6, 2020. Using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework, in January 2019, the 13-member Workgroup and 16 additional clinical and scientific experts, nurses, patient representatives, and a methodologist developed clinical recommendations. A statement of good practice was made when there was a high level of certainty that the recommendation would do more good than harm, but there was little direct evidence. Findings: From 11 295 literature citations associated with 10 PICO questions, 20 relevant studies were identified. An updated search identified 2 additional studies, for a total of 22 included studies (3 systematic reviews, 19 primary studies), which were reviewed and synthesized. Based on this analysis, 14 recommendations and 4 statements of good practice were developed. Overall, the evidence base was limited. Only 1 strong recommendation was formulated: screening for Alzheimer-type dementia starting at age 40 years. Four recommendations (managing risk factors for cardiovascular disease and stroke prevention, screening for obesity, and evaluation for secondary causes of osteoporosis) agreed with existing guidance for individuals without Down syndrome. Two recommendations for diabetes screening recommend earlier initiation of screening and at shorter intervals given the high prevalence and earlier onset in adults with Down syndrome. Conclusions and Relevance: These evidence-based clinical guidelines provide recommendations to support primary care of adults with Down syndrome. The lack of high-quality evidence limits the strength of the recommendations and highlights the need for additional research.


Asunto(s)
Síndrome de Down/terapia , Adulto , Enfermedad de Alzheimer/complicaciones , Enfermedad de Alzheimer/epidemiología , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/prevención & control , Comorbilidad , Complicaciones de la Diabetes/epidemiología , Síndrome de Down/complicaciones , Medicina Basada en la Evidencia , Humanos , Tamizaje Masivo , Obesidad/complicaciones
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