Aterosclerosis subclínica, un predictor de limitación funcional al año en ancianos con alto nivel funcional: estudio Albacete / Subclinial atherosclerosis as a predictor of functional limitation at one year in high-functioning older adults: the Albacete study

IntroducciónLa aterosclerosis subclínica se ha asociado con morbimortalidad cardiovascular, pero no se ha analizado su relación con limitación funcional como antesala de la discapacidad.Material y métodosEstudio longitudinal sobre 171 mayores de 64 años con alto nivel funcional. Edad media 73,7 años, 110 mujeres. Se les realizó eco-Doppler carotídeo al inicio del estudio determinando la presencia de placas y la suma del diámetro axial máximo de todas las placas (SDP) y fueron seguidos 12 meses. Analizamos la asociación entre aterosclerosis subclínica y limitación funcional valorada con el timed up and go (TUG) al año, ajustada por covariables sociodemográficas, funcionales, afectivas, cognitivas y factores de riesgo cardiovascular.ResultadosTreinta y siete sujetos (21,6%) realizaron el TUG un 20% más lentamente al año que al inicio, 30 con placa (30,7%) y 7 sin placa (9,5%) (p=0,001). Aquellos con placa tuvieron un mayor riesgo ajustado de enlentecer el TUG más del 20% que aquéllos sin placa (OR: 5,8; IC del 95%: 2,2–15,8). Los que enlentecieron el TUG más del 20% tuvieron una SDP 1,48mm mayor (3,34 vs. 1,85; IC del 95%: 0,52–2,44). Por cada aumento de 2mm en la SDP, los sujetos tuvieron un riesgo ajustado 1,9 veces mayor de realizar el TUG más lentamente al año (IC del 95%: 1,4–2,5).ConclusiónLa aterosclerosis subclínica es un predictor independiente de limitación funcional al año en ancianos con alto nivel funcional(AU)

IntroductionSubclinical atherosclerosis is associated with cardiovascular morbidity and mortality, but its relationship with functional limitation as a precursor of disability has not been determined.Material and methodsA longitudinal cohort study was performed in 171 high-functioning community-dwelling adults aged more than 64 years old (mean age 73.7 years, 110 women). All received a carotid ultrasound examination at the beginning of the study. Subclinical atherosclerosis was determined by the presence or absence of atherosclerotic plaques and the sum of the diameters of all the plaques (SDP) in the carotid bilateral tree. Subjects were followed-up at 12 months. The association between subclinical atherosclerosis and functional limitation was assessed with the Timed Up and Go test (TUG) at entry and at 1 year, adjusted by demographic, functional, affective, cognitive and cardiovascular risk factors as covariables.ResultsAt 1 year after baseline, 37 subjects (21.6%) performed the TUG 20% more slowly: 30 with plaque (30.7%) and seven without plaque (9.5%) (p=0.001). Those with plaque had an adjusted increased risk of performing the TUG 20% more slowly than those without plaque [OR 5.5, 95% CI 2.2–15.8]. SDP was 1.48mm greater in subjects with more than 20% slowing on the TUG [3.34 vs 1.85; 95% CI 0.52–2.44]. For each 2-mm increment in the SDP, subjects had a 1.9-fold greater adjusted risk of performing the TUG 20% more slowly at 1 year [95% CI 1.4–2.5].ConclusionSubclinical atherosclerosis is an independent predictor of functional limitation at 1 year in high-functioning older adults(AU)

[Subclinial atherosclerosis as a predictor of functional limitation at one year in high-functioning older adults: the Albacete study]. / Aterosclerosis subclínica, un predictor de limitación funcional al año en ancianos con alto nivel funcional: estudio Albacete.

INTRODUCTION: Subclinical atherosclerosis is associated with cardiovascular morbidity and mortality, but its relationship with functional limitation as a precursor of disability has not been determined. MATERIAL AND METHODS: A longitudinal cohort study was performed in 171 high-functioning community-dwelling adults aged more than 64 years old (mean age 73.7 years, 110 women). All received a carotid ultrasound examination at the beginning of the study. Subclinical atherosclerosis was determined by the presence or absence of atherosclerotic plaques and the sum of the diameters of all the plaques (SDP) in the carotid bilateral tree. Subjects were followed-up at 12 months. The association between subclinical atherosclerosis and functional limitation was assessed with the Timed Up and Go test (TUG) at entry and at 1 year, adjusted by demographic, functional, affective, cognitive and cardiovascular risk factors as covariables. RESULTS: At 1 year after baseline, 37 subjects (21.6%) performed the TUG 20% more slowly: 30 with plaque (30.7%) and seven without plaque (9.5%) (p=0.001). Those with plaque had an adjusted increased risk of performing the TUG 20% more slowly than those without plaque [OR 5.5, 95% CI 2.2-15.8]. SDP was 1.48 mm greater in subjects with more than 20% slowing on the TUG [3.34 vs 1.85; 95% CI 0.52-2.44]. For each 2-mm increment in the SDP, subjects had a 1.9-fold greater adjusted risk of performing the TUG 20% more slowly at 1 year [95% CI 1.4-2.5]. CONCLUSION: Subclinical atherosclerosis is an independent predictor of functional limitation at 1 year in high-functioning older adults.

Paraganglioma of the bladder: controversy regarding treatment.

Paragangliomas or extra-adrenal pheochromocytomas account for approximately 15% of all pheochromocytomas. They are usually found in an intradiaphragmatic location. Paragangliomas of the urinary bladder are infrequent and represent 6% of the paragangliomas and 0.06% of all bladder tumors. We describe 2 cases of urinary bladder paragangliomas attended to our center and review the literature with special attention to treatment, since there is some controversy around the management of these tumors. Surgical options include partial or total cystectomy and transurethral resection, but there is no consensus regarding these treatment modalities. The 2 patients presented underwent transurethral resection with a good outcome and no recurrence or residual disease.