Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus.

Adequate lifestyle changes significantly reduce the cardiovascular risk factors associated with prediabetes and type 2 diabetes mellitus. Therefore, healthy eating habits, regular physical activity, abstaining from using tobacco, and good sleep hygiene are recommended for managing these conditions. There is solid evidence that diets that are plant-based; low in saturated fatty acids, cholesterol, and sodium; and high in fiber, potassium, and unsaturated fatty acids are beneficial and reduce the expression of cardiovascular risk factors in these subjects. In view of the foregoing, the Mediterranean diet, the DASH diet, a low-carbohydrate diet, and a vegan-vegetarian diet are of note. Additionally, the relationship between nutrition and these metabolic pathologies is fundamental in targeting efforts to prevent weight gain, reducing excess weight in the case of individuals with overweight or obesity; and personalizing treatment to promote patient empowerment. This document is the executive summary of an updated review that includes the main recommendations for improving dietary nutritional quality in people with prediabetes or type 2 diabetes mellitus. The full review is available on the webpages of the Spanish Society of Arteriosclerosis (SEA, for its initials in Spanish), the Spanish Diabetes Society (SED, for its initials in Spanish), and the Spanish Society of Internal Medicine (SEMI, for its initials in Spanish).

Resumen ejecutivo: actualización en el tratamiento dietético de la prediabetes y la diabetes mellitus tipo 2 / Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus

Los cambios adecuados del estilo de vida reducen significativamente los factores de riesgo cardiovascular asociados a la prediabetes y la diabetes mellitus tipo 2, por lo que en su manejo se debe recomendar un patrón saludable de alimentación, actividad física regular, no consumir tabaco, y una buena higiene del sueño. Hay una sólida evidencia de que los patrones alimentarios de base vegetal, bajos en ácidos grasos saturados, colesterol y sodio, con un alto contenido en fibra, potasio y ácidos grasos insaturados, son beneficiosos y reducen la expresión de los factores de riesgo cardiovascular en estos sujetos. En este contexto destacan la dieta mediterránea, la dieta DASH, la dieta baja en hidratos de carbono y la dieta vegano-vegetariana. Adicionalmente, en la relación entre nutrición y estas enfermedades metabólicas es fundamental dirigir los esfuerzos a prevenir la ganancia de peso o a reducir su exceso en caso de sobrepeso u obesidad, y personalizar el tratamiento para favorecer el empoderamiento del paciente.Este documento es un resumen ejecutivo de una revisión actualizada que incluye las principales recomendaciones para mejorar la calidad nutricional de la alimentación en las personas con prediabetes o diabetes mellitus tipo 2, disponible en las páginas web de la Sociedad Española de Arteriosclerosis, la Sociedad Española de Diabetes y la Sociedad Española de Medicina Interna.(AU)

Adequate lifestyle changes significantly reduce the cardiovascular risk factors associated with prediabetes and type 2 diabetes mellitus. Therefore, healthy eating habits, regular physical activity, abstaining from using tobacco, and good sleep hygiene are recommended for managing these conditions. There is solid evidence that diets that are plant-based; low in saturated fatty acids, cholesterol, and sodium; and high in fiber, potassium, and unsaturated fatty acids are beneficial and reduce the expression of cardiovascular risk factors in these subjects. In view of the foregoing, the Mediterranean diet, the DASH diet, a low-carbohydrate diet, and a vegan-vegetarian diet are of note. Additionally, the relationship between nutrition and these metabolic pathologies is fundamental in targeting efforts to prevent weight gain, reducing excess weight in the case of individuals with overweight or obesity, and personalizing treatment to promote patient empowerment.This document is the executive summary of an updated review that includes the main recommendations for improving dietary nutritional quality in people with prediabetes or type 2 diabetes mellitus. The full review is available on the webpages of the Spanish Society of Arteriosclerosis, the Spanish Diabetes Society, and the Spanish Society of Internal Medicine.(AU)

Resumen ejecutivo: actualización en el tratamiento dietético de la prediabetes y la diabetes mellitus tipo 2 / Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus

Los cambios adecuados del estilo de vida reducen significativamente los factores de riesgo cardiovascular asociados a la prediabetes y la diabetes mellitus tipo 2, por lo que en su manejo se debe recomendar un patrón saludable de alimentación, actividad física regular, no consumir tabaco, y una buena higiene del sueño. Hay una sólida evidencia de que los patrones alimentarios de base vegetal, bajos en ácidos grasos saturados, colesterol y sodio, con un alto contenido en fibra, potasio y ácidos grasos insaturados, son beneficiosos y reducen la expresión de los factores de riesgo cardiovascular en estos sujetos. En este contexto destacan la dieta mediterránea, la dieta DASH, la dieta baja en hidratos de carbono y la dieta vegano-vegetariana. Adicionalmente, en la relación entre nutrición y estas enfermedades metabólicas es fundamental dirigir los esfuerzos a prevenir la ganancia de peso o a reducir su exceso en caso de sobrepeso u obesidad, y personalizar el tratamiento para favorecer el empoderamiento del paciente. Este documento es un resumen ejecutivo de una revisión actualizada que incluye las principales recomendaciones para mejorar la calidad nutricional de la alimentación en las personas con prediabetes o diabetes mellitus tipo 2, disponible en las páginas web de la Sociedad Española de Arteriosclerosis, la Sociedad Española de Diabetes y la Sociedad Española de Medicina Interna (AU)

Adequate lifestyle changes significantly reduce the cardiovascular risk factors associated with prediabetes and type 2 diabetes mellitus. Therefore, healthy eating habits, regular physical activity, abstaining from using tobacco, and good sleep hygiene are recommended for managing these conditions. There is solid evidence that diets that are plant-based; low in saturated fatty acids, cholesterol, and sodium; and high in fiber, potassium, and unsaturated fatty acids are beneficial and reduce the expression of cardiovascular risk factors in these subjects. In view of the foregoing, the Mediterranean diet, the DASH diet, a low-carbohydrate diet, and a vegan-vegetarian diet are of note. Additionally, the relationship between nutrition and these metabolic pathologies is fundamental in targeting efforts to prevent weight gain, reducing excess weight in the case of individuals with overweight or obesity, and personalizing treatment to promote patient empowerment. This document is the executive summary of an updated review that includes the main recommendations for improving dietary nutritional quality in people with prediabetes or type 2 diabetes mellitus. The full review is available on the webpages of the Spanish Society of Arteriosclerosis, the Spanish Diabetes Society, and the Spanish Society of Internal Medicine (AU)

Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus. / Resumen ejecutivo: actualización en el tratamiento dietético de la prediabetes y la diabetes mellitus tipo 2.

Adequate lifestyle changes significantly reduce the cardiovascular risk factors associated with prediabetes and type 2 diabetes mellitus. Therefore, healthy eating habits, regular physical activity, abstaining from using tobacco, and good sleep hygiene are recommended for managing these conditions. There is solid evidence that diets that are plant-based; low in saturated fatty acids, cholesterol, and sodium; and high in fiber, potassium, and unsaturated fatty acids are beneficial and reduce the expression of cardiovascular risk factors in these subjects. In view of the foregoing, the Mediterranean diet, the DASH diet, a low-carbohydrate diet, and a vegan-vegetarian diet are of note. Additionally, the relationship between nutrition and these metabolic pathologies is fundamental in targeting efforts to prevent weight gain, reducing excess weight in the case of individuals with overweight or obesity, and personalizing treatment to promote patient empowerment. This document is the executive summary of an updated review that includes the main recommendations for improving dietary nutritional quality in people with prediabetes or type 2 diabetes mellitus. The full review is available on the webpages of the Spanish Society of Arteriosclerosis, the Spanish Diabetes Society, and the Spanish Society of Internal Medicine.

Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus. / Resumen ejecutivo: actualización en el tratamiento dietético de la prediabetes y la diabetes mellitus tipo 2.

Adequate lifestyle changes significantly reduce the cardiovascular risk factors associated with prediabetes and type 2 diabetes mellitus. Therefore, healthy eating habits, regular physical activity, abstaining from using tobacco, and good sleep hygiene are recommended for managing these conditions. There is solid evidence that diets that are plant-based; low in saturated fatty acids, cholesterol, and sodium; and high in fiber, potassium, and unsaturated fatty acids are beneficial and reduce the expression of cardiovascular risk factors in these subjects. In view of the foregoing, the Mediterranean diet, the DASH diet, a low-carbohydrate diet, and a vegan-vegetarian diet are of note. Additionally, the relationship between nutrition and these metabolic pathologies is fundamental in targeting efforts to prevent weight gain, reducing excess weight in the case of individuals with overweight or obesity, and personalizing treatment to promote patient empowerment. This document is the executive summary of an updated review that includes the main recommendations for improving dietary nutritional quality in people with prediabetes or type 2 diabetes mellitus. The full review is available on the webpages of the Spanish Society of Arteriosclerosis, the Spanish Diabetes Society, and the Spanish Society of Internal Medicine.

Retrospective cohort study of clinical characteristics of 2199 hospitalised patients with COVID-19 in New York City.

OBJECTIVE: The COVID-19 pandemic is a global public health crisis, with over 33 million cases and 999 000 deaths worldwide. Data are needed regarding the clinical course of hospitalised patients, particularly in the USA. We aimed to compare clinical characteristic of patients with COVID-19 who had in-hospital mortality with those who were discharged alive. DESIGN: Demographic, clinical and outcomes data for patients admitted to five Mount Sinai Health System hospitals with confirmed COVID-19 between 27 February and 2 April 2020 were identified through institutional electronic health records. We performed a retrospective comparative analysis of patients who had in-hospital mortality or were discharged alive. SETTING: All patients were admitted to the Mount Sinai Health System, a large quaternary care urban hospital system. PARTICIPANTS: Participants over the age of 18 years were included. PRIMARY OUTCOMES: We investigated in-hospital mortality during the study period. RESULTS: A total of 2199 patients with COVID-19 were hospitalised during the study period. As of 2 April, 1121 (51%) patients remained hospitalised, and 1078 (49%) completed their hospital course. Of the latter, the overall mortality was 29%, and 36% required intensive care. The median age was 65 years overall and 75 years in those who died. Pre-existing conditions were present in 65% of those who died and 46% of those discharged. In those who died, the admission median lymphocyte percentage was 11.7%, D-dimer was 2.4 µg/mL, C reactive protein was 162 mg/L and procalcitonin was 0.44 ng/mL. In those discharged, the admission median lymphocyte percentage was 16.6%, D-dimer was 0.93 µg/mL, C reactive protein was 79 mg/L and procalcitonin was 0.09 ng/mL. CONCLUSIONS: In our cohort of hospitalised patients, requirement of intensive care and mortality were high. Patients who died typically had more pre-existing conditions and greater perturbations in inflammatory markers as compared with those who were discharged.

¿Han influido el algoritmo de prescripción de la Administración y las guías de manejo de la dislipemia de la ACC/AHA 2013 en el manejo de la dislipemia? Proyecto MEJORA-LO CV / Have the Government's prescription algorithm and the 2013 American College of Cardiology/American Heart Association guidelines for managing dyslipidaemia influenced the management of dyslipidaemia? The MEJORALO-CV Project

OBJETIVO: Conocer el manejo de la dislipemia en atención primaria tras la publicación de la Guía de la American College of Cardiology/American Heart Association (ACC/AHA) del año 2013 y el algoritmo de la Administración. MÉTODO: Estudio transversal descriptivo con encuesta a médicos de atención primaria de la Comunidad Valenciana entre enero y octubre de 2016. RESULTADOS: Participaron 199 facultativos con una media (desviación típica) de 48,9 (11) años de edad y 21,3 (11,1) años de experiencia. Las guías más seguidas eran las de la European Society of Cardiology (37,5%) y las de la Administración (23,4%). El 6,3% seguía la de la ACC/AHA 2013. El 88% establecía objetivos según colesterol LDL y riesgo cardiovascular. La elección del hipolipemiante estaba basada en su capacidad reductora de colesterol LDL (28,6%), algoritmo de la Administración (23,4%) y seguridad (20,4%). Estatinas, ezetimiba y fibratos eran los hipolipemiantes preferidos, y la combinación (51%) e incremento de dosis (35%) las estrategias en ausencia de control. Se determinaba perfil lipídico, transaminasas y creatincinasa cada 6 (59,5; 52,3 y 54,3%, respectivamente) o 12 meses (25,1; 29,2 y 30,3%, respectivamente). Un 41% era conocedor de la polémica con la Guía ACC/AHA 2013, y aunque un 60% reconocía su relevancia, solo un 21% modificó su quehacer diario por ella. CONCLUSIONES: El algoritmo de la Administración tuvo mayor impacto que la Guía ACC/AHA 2013 en atención primaria. Campos de mejora fueron el bajo uso de guías y tablas de riesgo validadas, y racionalización de la periodicidad de las analíticas

OBJECTIVE: To determine the management of dyslipidaemia in primary care after the publication of the American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines and Valencian government's algorithm. METHOD: We conducted a cross-sectional descriptive study that employed a survey of primary care physicians of the Community of Valencia between January and October 2016. RESULTS: A total of 199 physicians (mean age, 48.9±11.0 years; experience, 21.3±11.1 years) participated in the survey. The most followed guidelines were those of the European Society of Cardiology (37.5% of respondents) and Valencian government (23.4% of respondents). Some 6.3% of the respondents followed the 2013 ACC/AHA guidelines, and 88.0% established objectives based on LDL cholesterol and cardiovascular risk. The choice of lipid-lowering drug was based on its LDL cholesterol lowering capacity (28.6% of respondents), on the Valencian government's algorithm (23.4%) and on the drug's safety (20.4%). Statins, ezetimibe and fibrates were the preferred hypolipemiant agents, and their combination (51% of respondents) and dosage increases (35%) were the strategies employed for poor control. Lipid profile and transaminase and creatine kinase levels were measured every 6 (59.5%, 52.3% and 54.3% of respondents, respectively) or 12 months (25.1%, 29.2% and 30.3%, respectively). Forty-one percent of the respondents were aware of the controversy surrounding the 2013 ACC/AHA guidelines. Although 60% of the respondents acknowledged its relevance, only 21% changed their daily practices accordingly. CONCLUSIONS: The Valencian government's algorithm had a greater impact than the 2013 ACC/AHA guidelines in primary care in Valencia. Areas for improvement included the low use of validated guidelines and risk tables and the streamlining of laboratory test periodicity

Have the Government's prescription algorithm and the 2013 American College of Cardiology/American Heart Association guidelines for managing dyslipidaemia influenced the management of dyslipidaemia? The MEJORALO-CV Project. / ¿Han influido el algoritmo de prescripción de la Administración y las guías de manejo de la dislipemia de la ACC/AHA 2013 en el manejo de la dislipemia? Proyecto MEJORA-LO CV.

OBJECTIVE: To determine the management of dyslipidaemia in primary care after the publication of the American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines and Valencian government's algorithm. METHOD: We conducted a cross-sectional descriptive study that employed a survey of primary care physicians of the Community of Valencia between January and October 2016. RESULTS: A total of 199 physicians (mean age, 48.9±11.0 years; experience, 21.3±11.1 years) participated in the survey. The most followed guidelines were those of the European Society of Cardiology (37.5% of respondents) and Valencian government (23.4% of respondents). Some 6.3% of the respondents followed the 2013 ACC/AHA guidelines, and 88.0% established objectives based on LDL cholesterol and cardiovascular risk. The choice of lipid-lowering drug was based on its LDL cholesterol lowering capacity (28.6% of respondents), on the Valencian government's algorithm (23.4%) and on the drug's safety (20.4%). Statins, ezetimibe and fibrates were the preferred hypolipemiant agents, and their combination (51% of respondents) and dosage increases (35%) were the strategies employed for poor control. Lipid profile and transaminase and creatine kinase levels were measured every 6 (59.5%, 52.3% and 54.3% of respondents, respectively) or 12 months (25.1%, 29.2% and 30.3%, respectively). Forty-one percent of the respondents were aware of the controversy surrounding the 2013 ACC/AHA guidelines. Although 60% of the respondents acknowledged its relevance, only 21% changed their daily practices accordingly. CONCLUSIONS: The Valencian government's algorithm had a greater impact than the 2013 ACC/AHA guidelines in primary care in Valencia. Areas for improvement included the low use of validated guidelines and risk tables and the streamlining of laboratory test periodicity.

Efecto de la segmentación por tejidos en los mapas de atenuación sobre la cuantificación PET con especial hincapié en grandes arterias / The effect of tissue-segmented attenuation maps on PET quantification with a special focus on large arteries

Objetivos. La precisión cuantitativa en PET requiere una adecuada aplicación de la corrección de atenuación, lo cual representa uno de los mayores retos que aún están por resolver en la técnica PET/RM. El propósito de este estudio es evaluar el efecto de utilizar mapas de atenuación basados en RM y el uso de antenas flexibles sobre la precisión cuantitativa en PET con especial hincapié en grandes arterias. Materiales y métodos. Se utilizaron datos PET/TC de 8 pacientes oncológicos. Los datos PET fueron reconstruidos utilizando mapas de atenuación con diferente nivel de detalle emulando las distintas aproximaciones utilizadas actualmente por lo equipos PET/RM. Las imágenes PET obtenidas con mapas de atenuación basados en TC y RM fueron comparadas para evaluar las desviaciones cuantitativas obtenidas. El efecto producido por las antenas flexibles fue también estudiado. Resultados. El uso de mapas de atenuación más simplificados da lugar a un incremento en las desviaciones cuantitativas en grasa, tejido blando y hueso. Las desviaciones en pulmón son altas debido a su heterogeneidad y a la variabilidad entre pacientes. La cuantificación en grandes arterias muestra pequeñas desviaciones excepto en el caso de utilizar antenas flexibles. La cuantificación mediante TBR proporciona menores desviaciones al cancelarse las desviaciones medidas en arterias y las venas utilizadas como referencia. Conclusiones. Los mapas de atenuación simplificados que se utilizan en PET/RM producen un incremento significativo de variabilidad cuantitativa especialmente en pulmones y huesos. La cuantificación aplicada al estudio de la aterosclerosis produce pequeñas desviaciones, especialmente cuando se utiliza el TBR (AU)

Objectives. Accuracy on quantitative PET image analysis relies on the correct application of attenuation correction which is one of the major challenges for PET/MRI that remains to be solved. The purpose of this study is to evaluate the effect of MRI-based attenuation maps and the use of flexible coils on the quantitative accuracy of PET images with a special focus on large arteries. Materials and methods. PET/CT data from eight oncologic patients was used. PET data was reconstructed using attenuation maps with different level of detail emulating several approaches available on current PET/MRI scanners. PET images obtained with CT-based and MRI-based attenuation maps were compared to evaluate the quantitative biases obtained. The quantitative effect produced by flexible MRI receiver coils on the attenuation maps was also studied. Results. The use of simpler attenuation maps produced increased biases between PET data reconstructed with CT-based and MRI-based attenuation maps for fat, non-fat soft-tissues and bone. Biases in lung were very high due to the large heterogeneity and inter-patient variability of the lung. The quantification on large arteries had small deviations except for the case when flexible coils were used. The TBR provided smaller biases in all cases as it cancelled out the similar deviations obtained for arteries and reference veins. Conclusions. Simplified attenuation maps used on PET/MRI significantly increase the quantitative variability of PET images especially on lungs and bones. The quantification of PET images acquired with PET/MRI scanners applied to studies of atherosclerosis has small deviations, especially when the TBR is considered (AU)

The effect of tissue-segmented attenuation maps on PET quantification with a special focus on large arteries. / Efecto de la segmentación por tejidos en los mapas de atenuación sobre la cuantificación PET con especial hincapié en grandes arterias.

OBJECTIVES: Accuracy on quantitative PET image analysis relies on the correct application of attenuation correction which is one of the major challenges for PET/MRI that remains to be solved. The purpose of this study is to evaluate the effect of MRI-based attenuation maps and the use of flexible coils on the quantitative accuracy of PET images with a special focus on large arteries. MATERIALS AND METHODS: PET/CT data from eight oncologic patients was used. PET data was reconstructed using attenuation maps with different level of detail emulating several approaches available on current PET/MRI scanners. PET images obtained with CT-based and MRI-based attenuation maps were compared to evaluate the quantitative biases obtained. The quantitative effect produced by flexible MRI receiver coils on the attenuation maps was also studied. RESULTS: The use of simpler attenuation maps produced increased biases between PET data reconstructed with CT-based and MRI-based attenuation maps for fat, non-fat soft-tissues and bone. Biases in lung were very high due to the large heterogeneity and inter-patient variability of the lung. The quantification on large arteries had small deviations except for the case when flexible coils were used. The TBR provided smaller biases in all cases as it cancelled out the similar deviations obtained for arteries and reference veins. CONCLUSIONS: Simplified attenuation maps used on PET/MRI significantly increase the quantitative variability of PET images especially on lungs and bones. The quantification of PET images acquired with PET/MRI scanners applied to studies of atherosclerosis has small deviations, especially when the TBR is considered.

Pharmacological management of dyslipidemia in high and very high cardiovascular risk patients.

Dyslipaemia is one of the main risk factors in the development of cardiovascular diseases. Currently, there are different alternatives available (amongst which statins occupy a pre-eminent place), to optimise the treatment of patients at high or very high cardiovascular risk. Despite this, the percentage of patients that achieve good lipid control is low. The causes of the mismatch with proposed objectives include lack of patient adherence and therapeutic inertia. This review uses available evidence and the latest clinical guides as a basis to assess the pharmacological treatment of dyslipaemia in patients with a background of arteriosclerotic vascular disease, diabetes, chronic kidney disease, cardiovascular risk at ≥5% calculated by SCORE and familial hypercholesterolaemia. The treatment of hypertriglyceridemia is also reviewed along with the special consideration that poly-pharmacy deserves in patients treated with statins, making mention of the treatment of dyslipaemia with HIV infection. The global assessment of cardiovascular risk is of high priority to adapt treatment to the specific objectives of the c-LDL for each risk category.

Exome sequencing of extreme clopidogrel response phenotypes identifies B4GALT2 as a determinant of on-treatment platelet reactivity.

Interindividual variability in platelet aggregation is common among patients treated with clopidogrel and both high on-treatment platelet reactivity (HTPR) and low on-treatment platelet reactivity (LTPR) increase risks for adverse clinical outcomes. CYP2C19 influences clopidogrel response but only accounts for ∼12% of the variability in platelet reactivity. To identify novel variants implicated in on-treatment platelet reactivity, patients with coronary artery disease (CAD) with extreme pharmacodynamic responses to clopidogrel and wild-type CYP2C19 were subjected to exome sequencing. Candidate variants that clustered in the LTPR subgroup subsequently were genotyped across the discovery cohort (n = 636). Importantly, carriers of B4GALT2 c.909C>T had lower on-treatment P2Y12 reaction units (PRUs; P = 0.0077) and residual platelet aggregation (P = 0.0008) compared with noncarriers, which remained significant after adjusting for CYP2C19 and other clinical variables in both the discovery (P = 0.0298) and replication (n = 160; PRU: P = 0.0001) cohorts. B4GALT2 is a platelet-expressed galactosyltransferase, indicating that B4GALT2 c.909C>T may influence clopidogrel sensitivity through atypical cell-surface glycoprotein processing and platelet adhesion.

Diffractive lenses recorded in absorbent photopolymers.

Photopolymers can be appealing materials for diffractive optical elements fabrication. In this paper, we present the recording of diffractive lenses in PVA/AA (Polyvinyl alcohol acrylamide) based photopolymers using a liquid crystal device as a master. In addition, we study the viability of using a diffusion model to simulate the lens formation in the material and to study the influence of the different parameters that govern the diffractive formation in photopolymers. Once we control the influence of each parameter, we can fit an optimum recording schedule to record each different diffractive optical element with the optimum focalization power.

Pacientes de alto riesgo cardiovascular. ¿Se pueden suprimir los hipolipemiantes? / No disponible

No disponible

Tratamiento farmacológico de la dislipemia en pacientes de alto y muy alto riesgo cardiovascular / Pharmacological management of dyslipidemia in high and very high cardiovascular risk patients

La dislipemia es uno de los principales factores de riesgo para el desarrollo de enfermedades cardiovasculares. Actualmente disponemos de diferentes alternativas (entre las que las estatinas ocupan un lugar preeminente), para optimizar el tratamiento en los pacientes de alto y muy alto riesgo cardiovascular. A pesar de ello, el porcentaje de pacientes que consigue un buen control lipídico es bajo, entre las causas de la inadecuación a los objetivos propuestos, figuran: la falta de adherencia del paciente y la inercia terapéutica. En esta revisión se valora en base a las evidencias disponibles y a las últimas guías clínicas, el tratamiento farmacológico de la dislipemia en pacientes con antecedentes de enfermedad vascular arteriosclerótica, diabetes, enfermedad renal crónica, riesgo cardiovascular ≥5% calculado por SCORE e hipercolesterolemia familiar. También se revisa el tratamiento de la hipertrigliceridemia y la consideración especial que merece la polimedicación en pacientes tratados con estatinas, haciendo mención al tratamiento de la dislipemia en aquellos con infección por VIH. La evaluación global del riesgo cardiovascular es prioritaria para adecuar el tratamiento a los objetivos específicos del c- LDL para cada categoría de riesgo (AU)

Dyslipaemia is one of the main risk factors in the development of cardiovascular diseases. Currently, there are different alternatives available (amongst which statins occupy a pre-eminent place), to optimise the treatment of patients at high or very high cardiovascular risk. Despite this, the percentage of patients that achieve good lipid control is low. The causes of the mismatch with proposed objectives include lack of patient adherence and therapeutic inertia. This review uses available evidence and the latest clinical guides as a basis to assess the pharmacological treatment of dyslipaemia in patients with a background of arteriosclerotic vascular disease, diabetes, chronic kidney disease, cardiovascular risk at ≥5% calculated by SCORE and familial hypercholesterolaemia. The treatment of hypertriglyceridemia is also reviewed along with the special consideration that poly-pharmacy deserves in patients treated with statins, making mention of the treatment of dyslipaemia with HIV infection. The global assessment of cardiovascular risk is of high priority to adapt treatment to the specific objectives of the c-LDL for each risk category (AU)

[Could the moderate consumption of beer be included within a healthy diet?]. / ¿El consumo moderado de cerveza podría incluirse dentro de una alimentación saludable?

INTRODUCTION: Beer is a beverage that has been usually included in our habitual diet from immemorial time. However, beer consumption depends on food habits and lifestyle in different populations. In Mediterranean countries, fermented beverages like beer, takes up a key space in the Mediterranean diet that has been declared in 2010 as Cultural Immaterial World Heritage by UNESCO. OBJECTIVES: The positioning where the Spanish Society of Primary Care Medicine and the Beer and Health Information Centre have conjointly worked on has the following beer consumption-related aims: a) to update its knowledge based on the scientific evidence; b) to evaluate the possibility to include it within a healthy diet for healthy adults; c) to inform health professionals and the general population about its possible health benefits. METHODOLOGY: A panel of experts, represented by clinicians and researchers in the field of nutrition held a meeting with the purpose to review the scientific literature related to the effects of the moderate consumption of fermented beverages, particularly beer, and to reach a consensus on the results, conclusions and recommendations suggested and established by other experts at an international level. RESULTS: The current scientific evidence reflects that moderate consumption of beer does not affect anthropometry related variables. Although energy supply from beer is very low, its nutrients and bioactive compound contents are interesting, since its potential antioxidant effect together with the fact that anti-carcinogenic, anti-inflammatory and anti-viral effects have been demonstrated, as well as its beneficial effect on cardiovascular health, leading to a greater protection than even in the abstemious population. CONCLUSIONS: In view of the results obtained from the literature consulted by the expert panel, we can conclude that the moderate consumption of beer can be considered within a healthy diet. Nevertheless, the general recommendation is addressed only to healthy adults, never to children, adolescents or pregnant women. In the case of elderly people, any beverage containing alcohol should not be recommended for those who are treated with drugs in order to avoid possible interactions with alcohol consumption.

Dislipidemia y riesgo vascular. Una revisión basada en nuevas evidencias / Dyslipidaemia and vascular risk. A new evidence based review

La dislipidemia es uno de los principales factores de riesgo de cardiopatía isquémica, primera causa de mortalidad en el mundo. Realizar una detección temprana y una intervención terapéutica precoz son elementos clave a la hora de establecer una adecuada prevención de una enfermedad cardiovascular. Debemos conocer el arsenal terapéutico de que disponemos para su adecuada utilización en cada una de las situaciones clínicas que puedan presentar nuestros pacientes. En los últimos 3 años, la proliferación de múltiples guías para el manejo clínico del paciente dislipidémico con aparentes mensajes contradictorios en relación con la consecución de los objetivos de control llegan a confundir a los médicos. En esta revisión se pretende ofrecer una visión actualizada de la situación de la dislipidemia, partiendo del posicionamiento de las guías tanto europeas como americanas, pasando por diferentes situaciones de riesgo y finalizando con el concepto de dislipidemia aterogénica, reconocido factor de riesgo cardiovascular (AU)

Dyslipidaemia is one of the major risk factors for ischaemic heart disease, the leading cause of death worldwide. Early detection and therapeutic intervention are key elements in the adequate prevention of cardiovascular disease. It is essential to have knowledge of the therapeutic arsenal available for their appropriate use in each of the clinical situations that might be presented in our patients. In the past 3 years, there has been a proliferation of multiple guidelines for the clinical management of patients with dyslipidaemia, with apparent contradictory messages regarding the achievement of the control objectives, which are confusing clinicians. This review aims to provide an updated overview of the situation as regards dyslipidaemia, based on the positioning of both European and American guidelines, through different risk situations and ending with the concept of atherogenic dyslipidaemia as a recognized cardiovascular risk factor (AU)

Development and validation of a questionnaire to evaluate lifestyle-related behaviors in elementary school children.

BACKGROUND: The SI! Program promotes cardiovascular health through a multilevel school-based intervention on four lifestyle-related components: diet, physical activity, understanding the body and heart, and management of emotions. We report here the development and validation of the KAH (knowledge, attitudes and habits)-questionnaire adapted for elementary school children (6-7 years old) as a tool for the forthcoming evaluation of the SI! Program, where the KAH scoring will be the primary outcome. The efficacy of such an intervention will be based on the improvements in children's KAH towards a healthy lifestyle. METHODS: The questionnaire validation process started with a pool of items proposed by the pedagogical team who developed the SI! Program for elementary school. The questionnaire was finalized by decreasing the number of items from 155 to 48 using expert panels and statistical tests on the responses from 384 children (ages 6-7). A team of specialized psychologists administered the questionnaire at schools providing standard directions for the final administration. The internal consistency was assessed using Cronbach's α coefficients. Reliability was measured through the split-half method, and problematic items were detected applying the item response theory. Analysis of variance and Tukey's test of additivity were used for multiple comparisons. RESULTS: The final KAH-questionnaire for elementary school children should be administered to children individually by trained staff. The 48 items-questionnaire is divided evenly between the 4 components of the intervention, with an overall Cronbach's α = 0.791 (α = 0.526 for diet, α = 0.537 for physical activity, α = 0.523 for human body and heart, and α = 0.537 for management of emotions). CONCLUSIONS: The KAH-questionnaire is a reliable instrument to assess the efficacy of the SI! Program on instilling healthy lifestyle-related behaviors in elementary school children.

¿El consumo moderado de cerveza podría incluirse dentro e una alimentación saludable? / Could the moderate consumption of beer be included within a healthy diet?

Introducción: La cerveza es una bebida que lleva formando parte de nuestra vida habitual desde tiempos inmemoriales. Sin embargo, su consumo depende de los hábitos alimentarios y del estilo de vida de las distintas poblaciones. En los países europeos situados en la cuenca mediterránea, las bebidas fermentadas como la cerveza ocupan un lugar clave en la dieta mediterránea, declarada en 2010 como Patrimonio Cultural Inmaterial de la Humanidad por la UNESCO. Objetivos: El posicionamiento en el que colaboran de forma conjunta un grupo de expertos de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN) y el Centro de Información Cerveza y Salud (CICS) tiene como objetivos, en relación con el consumo moderado de cerveza: a) actualizar el conocimiento basado en la evidencia científica; b) valorar la posibilidad de incluirlo dentro de una alimentación saludable para adultos sanos; c) informar sobre sus posibles beneficios a los profesionales de la salud y a la población en general. Metodología: Un panel de expertos, representado por clínicos e investigadores en el campo de la nutrición, se reunió para revisar la literatura científica relacionada con los efectos del consumo moderado de bebidas fermentadas, en particular de la cerveza, y consensuar resultados, conclusiones y recomendaciones emitidas por distintos autores en el ámbito internacional. Resultados: La evidencia científica actual refleja que el consumo moderado de cerveza no modifica los parámetros relacionados con la antropometría, tanto los pliegues cutáneos como el peso se mantienen. Su aporte energético es bajo, aunque el contenido en nutrientes y compuestos bioactivos es muy interesante, ya que se ha demostrado su potencial efecto antioxidante, anticarcinogénico, antiinflamatorio y antiviral, así como su efecto beneficioso sobre la salud cardiovascular, obteniéndose con ingestas moderadas una protección mayor que en población abstemia. Conclusiones: A la vista de los resultados obtenidos tras la consulta bibliográfica realizada por el panel de expertos, se puede concluir que el consumo moderado de cerveza puede considerarse como parte de una alimentación saludable. No obstante, el consumo moderado de cerveza tradicional está contemplado en adultos sanos, nunca en menores de edad, mujeres gestantes o personas mayores con medicación susceptible de interaccionar con la ingesta de alcohol (AU)

Introduction: Beer is a beverage that has been usually included in our habitual diet from immemorial time. However, beer consumption depends on food habits and lifestyle in different populations. In Mediterranean countries, fermented beverages like beer, takes up a key space in the Mediterranean diet that has been declared in 2010 as Cultural Immaterial World Heritage by UNESCO. Objectives: The positioning where the Spanish Society of Primary Care Medicine and the Beer and Health Information Centre have conjointly worked on has the following beer consumption-related aims: a) to update its knowledge based on the scientific evidence; b) to evaluate the possibility to include it within a healthy diet for healthy adults; c) to inform health professionals and the general population about its possible health benefits. Methodology: A panel of experts, represented by clinicians and researchers in the field of nutrition held a meeting with the purpose to review the scientific literature related to the effects of the moderate consumption of fermented beverages, particularly beer, and to reach a consensus on the results, conclusions and recommendations suggested and established by other experts at an international level. Results: The current scientific evidence reflects that moderate consumption of beer does not affect anthropometry related variables. Although energy supply from beer is very low, its nutrients and bioactive compound contents are interesting, since its potential antioxidant effect together with the fact that anti-carcinogenic, anti-inflammatory and anti-viral effects have been demonstrated, as well as its beneficial effect on cardiovascular health, leading to a greater protection than even in the abstemious population. Conclusions: In view of the results obtained from the literature consulted by the expert panel, we can conclude that the moderate consumption of beer can be considered within a healthy diet. Nevertheless, the general recommendation is addressed only to healthy adults, never to children, adolescents or pregnant women. In the case of elderly people, any beverage containing alcohol should not be recommended for those who are treated with drugs in order to avoid possible interactions with alcohol consumption (AU)