Prevalence of peripheral artery disease (PAD) and factors associated: An epidemiological analysis from the population-based Screening PRE-diabetes and type 2 DIAbetes (SPREDIA-2) study.

AIM: To describe the prevalence of Peripheral Artery Disease (PAD) in a random population sample and to evaluate its relationship with Mediterranean diet and with other potential cardiovascular risk factors such as serum uric acid and pulse pressure in individuals ranged 45 to 74 years. METHODS: Cross-sectional analysis of 1568 subjects (mean age 6.5 years, 43% males), randomly selected from the population. A fasting blood sample was obtained to determine glucose, lipids, and HbA1C levels. An oral glucose tolerance test was performed in non-diabetic subjects. PAD was evaluated by ankle-brachial index and/or having a prior diagnosis. RESULTS: PAD prevalence was 3.81% (95% CI, 2.97-4.87) for all participants. In men, PAD prevalence was significantly higher than in women [5.17% (95% CI, 3.74-7.11) vs. 2.78% (95% CI, 1.89-4.07); p = 0.014]. Serum uric acid in the upper quartile was associated with the highest odds ratio (OR) of PAD (for uric acid > 6.1 mg/dl, OR = 4.31; 95% CI, 1.49-12.44). The remaining variables more strongly associated with PAD were: Heart rate >90 bpm (OR = 4.16; 95%CI, 1.62-10.65), pulse pressure in the upper quartile (≥ 54 mmHg) (OR = 3.82; 95%CI, 1.50-9.71), adherence to Mediterranean diet (OR = 2.73; 95% CI, 1.48-5.04), and former smoker status (OR = 2.04; 95%CI, 1.00-4.16). CONCLUSIONS: Our results show the existence of a low prevalence of peripheral artery disease in a population aged 45-74 years. Serum uric acid, pulse pressure and heart rate >90 bpm were strongly associated with peripheral artery disease. The direct association between Mediterranean diet and peripheral artery disease that we have found should be evaluated through a follow-up study under clinical practice conditions.

Performance of the Finnish Diabetes Risk Score and a Simplified Finnish Diabetes Risk Score in a Community-Based, Cross-Sectional Programme for Screening of Undiagnosed Type 2 Diabetes Mellitus and Dysglycaemia in Madrid, Spain: The SPREDIA-2 Study.

AIM: To evaluate the performance of the Finnish Diabetes Risk Score (FINDRISC) and a simplified FINDRISC score (MADRISC) in screening for undiagnosed type 2 diabetes mellitus (UT2DM) and dysglycaemia. METHODS: A population-based, cross-sectional, descriptive study was carried out with participants with UT2DM, ranged between 45-74 years and lived in two districts in the north of metropolitan Madrid (Spain). The FINDRISC and MADRISC scores were evaluated using the area under the receiver operating characteristic curve method (ROC-AUC). Four different gold standards were used for UT2DM and any dysglycaemia, as follows: fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), HbA1c, and OGTT or HbA1c. Dysglycaemia and UT2DM were defined according to American Diabetes Association criteria. RESULTS: The study population comprised 1,426 participants (832 females and 594 males) with a mean age of 62 years (SD = 6.1). When HbA1c or OGTT criteria were used, the prevalence of UT2DM was 7.4% (10.4% in men and 5.2% in women; p<0.01) and the FINDRISC ROC-AUC for UT2DM was 0.72 (95% CI, 0.69-0.74). The optimal cut-off point was ≥13 (sensitivity = 63.8%, specificity = 65.1%). The ROC-AUC of MADRISC was 0.76 (95% CI, 0.72-0.81) with ≥13 as the optimal cut-off point (sensitivity = 84.8%, specificity = 54.6%). FINDRISC score ≥12 for detecting any dysglycaemia offered the best cut-off point when HbA1c alone or OGTT and HbA1c were the criteria used. CONCLUSIONS: FINDRISC proved to be a useful instrument in screening for dysglycaemia and UT2DM. In the screening of UT2DM, the simplified MADRISC performed as well as FINDRISC.

Esclerodermia y paniculitis localizadas / Localized scleroderma and panniculitis

La esclerodermia es una enfermedad del tejido conectivo, autoinmunitaria y caracterizada por fibrosis de la piel1-3. Literalmente significa 'piel dura'. La afectación puede ser mínima (solo en dedos y cara, muy lentamente progresiva) o generalizada (afectando de forma rápida a uno o más órganos internos). La paniculitis neutrofílica4,6 es una respuesta inmunitaria localizada en forma de placa o nódulo, en el seno generalmente de una enfermedad sistémica (AU)

Scleroderma is a disease that affects the connective tissue. It is an autoimmune disease and it is characterized by skin fibrosis. It literally means 'hard skin'. The involvement can be minimal (only fingers and face, progressing slowly) or generalized (quickly affecting one or two internal organs). Neutrophilic panniculitis is an immune response located in the form of a plate or nodule, generally related to a systemic disease (AU)

Síndrome metabólico en pacientes con enfermedad arterial periférica / Metabolic syndrome in patients with peripheral arterial disease

Antecedentes y objetivos. La prevalencia del síndrome metabólico (SM) en pacientes con enfermedad arterial periférica (EAP) y arteriosclerosis de otros territorios está incrementada, pero se desconoce si también lo está en pacientes con EAP aislada. En pacientes con EAP, sin otra enfermedad aterosclerótica, hemos evaluado la prevalencia del SM y el grado de control de los factores de riesgo y fármacos cardiovasculares en comparación con enfermos sin SM. Pacientes y métodos. Estudio transversal multicéntrico, subestudio del PERIFÉRICA, realizado en consultas de atención primaria y especializada en 2009. Se incluyeron 3.934 pacientes, con ≥45 años y EAP documentada mediante el índice tobillo-brazo <0,9, amputación o revascularización arterial, sin antecedentes de enfermedad coronaria y/o cerebrovascular. Resultados. La edad media fue 67,6 años y el 73,8% eran varones. La prevalencia del SM fue del 63% (IC95% 61,5-64,3%). Los pacientes con SM tenían mayor prevalencia de factores de riesgo, mayor comorbilidad, una EAP más grave y utilizaban más frecuentemente fármacos cardiovasculares. Tras ajustar por factores de riesgo y comorbilidad, los bloqueadores del sistema renina-angiotensina, betabloqueantes, diuréticos y estatinas eran los fármacos utilizados con mayor frecuencia. Los objetivos de presión arterial (22% vs. 41,5%, p<0,001) y de HbA1c en pacientes diabéticos (44% vs. 53,1%, p<0,001) se alcanzaron menos frecuentemente en los pacientes con SM que en los que no tenían esta condición, sin que hubiera diferencias en cuanto al colesterol-LDL (29,8% vs. 39,1%, p=0,265). Conclusión. Cerca de dos tercios de los pacientes con EAP padecen el SM. A pesar de utilizar más fármacos cardiovasculares los objetivos terapéuticos se alcanzan en una menor proporción que en los pacientes sin SM (AU)

Background and objective. The prevalence of metabolic syndrome (MS) in patients with peripheral arterial disease (PAD) and coronary or cerebrovascular disease is increasing, but it is not known whether this association also exists in patients with isolated PAD. The aim of the current study was to assess the prevalence of MS in patients with PAD who had no coronary or cerebrovascular disease, the prescription rate of evidence-based cardiovascular therapies and the attainment of therapeutic goals in patients with PAD and with and without MS. Patients and methods. Multicenter, cross-sectional study of 3.934 patients aged ≥ 45 years with isolated PAD who were treated in primary care and specialized outpatient clinics during 2009. A diagnosis of PAD was reached for ankle brachial indices <0.9, a previous history of amputation or revascularization. Results. In the overall population, the mean age was 67.6 years, 73.8% were males and 63% had MS (95% CI 61.5-64.3%). Patients with MS had a higher prevalence of cardiovascular risk factors and comorbidities, more severe PAD and higher prescription rate of evidence-based cardiovascular therapies. After adjusting for risk factors and comorbidity, there was a more frequent use of renin-angiotensin system blockers, beta-blockers, diuretics and statins among the patients with MS. A lower percentage of patients with MS achieved the therapeutic goals for blood pressure (22% vs. 41.5%, p<0.001). Similarly, a lower percentage of patients with diabetes achieved the glycated hemoglobin goals (44% vs. 53.1%, p<0.001), with no differences in LDL-cholesterol levels (29.8% vs. 39.1%, p=0.265). Conclusion. Patients with PAD have a high prevalence of MS. Patients with MS do not attain therapeutic goals as frequently as those without, despite taking more cardiovascular drugs (AU)

Metabolic syndrome in patients with peripheral arterial disease. / Síndrome metabólico en pacientes con enfermedad arterial periférica.

BACKGROUND AND OBJECTIVE: The prevalence of metabolic syndrome (MS) in patients with peripheral arterial disease (PAD) and coronary or cerebrovascular disease is increasing, but it is not known whether this association also exists in patients with isolated PAD. The aim of the current study was to assess the prevalence of MS in patients with PAD who had no coronary or cerebrovascular disease, the prescription rate of evidence-based cardiovascular therapies and the attainment of therapeutic goals in patients with PAD and with and without MS. PATIENTS AND METHODS: Multicenter, cross-sectional study of 3.934 patients aged ≥ 45 years with isolated PAD who were treated in primary care and specialized outpatient clinics during 2009. A diagnosis of PAD was reached for ankle brachial indices <0.9, a previous history of amputation or revascularization. RESULTS: In the overall population, the mean age was 67.6 years, 73.8% were males and 63% had MS (95% CI 61.5-64.3%). Patients with MS had a higher prevalence of cardiovascular risk factors and comorbidities, more severe PAD and higher prescription rate of evidence-based cardiovascular therapies. After adjusting for risk factors and comorbidity, there was a more frequent use of renin-angiotensin system blockers, beta-blockers, diuretics and statins among the patients with MS. A lower percentage of patients with MS achieved the therapeutic goals for blood pressure (22% vs. 41.5%, p<0.001). Similarly, a lower percentage of patients with diabetes achieved the glycated hemoglobin goals (44% vs. 53.1%, p<0.001), with no differences in LDL-cholesterol levels (29.8% vs. 39.1%, p=0.265). CONCLUSION: Patients with PAD have a high prevalence of MS. Patients with MS do not attain therapeutic goals as frequently as those without, despite taking more cardiovascular drugs.

Mastocitoma solitario / Solitary mastocytoma

La mastocitosis consiste en una proliferación anormal de mastocitos en los tejidos, y el mastocitoma solitario es una de las formas más frecuentes. La evolución tiende a la curación espontánea, si bien un mínimo porcentaje de mastocitomas solitarios requieren extirpación quirúrgica (AU)

Mastocytosis is abnormal proliferation of tissue mast cells, being solitary mastocytoma the most common. Evolution tends to spontaneous healing, although a small percentage of solitary mastocytoma require surgical removal (AU)

¿Por qué los padres no vacunan a sus hijos? Reflexiones tras un brote de sarampión en un barrio de Granada / Why don’t parents vaccinate their children? Reflections on a measles outbreak in a neighbourhood of Granada

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Aplicación práctica del índice tobillo-brazo / Application of ankle-brachial index

La arteriosclerosis es una enfermedad sistémica y progresiva que se manifiesta clínicamente por la presencia de enfermedad coronaria, cerebrovascular o arterial periférica. Los sujetos con arteriosclerosis en un determinado lecho vascular tienen un riesgo elevado de presentar complicaciones vasculares futuras en un territorio distinto. El índice tobillo brazo (ITB) es una prueba sencilla e inocua, con una alta sensibilidad y especificidad para el diagnóstico de enfermedad arterial en miembros inferiores. Un ITB inferior a 0,9 identifica a un paciente de alto riesgo, con una elevada probabilidad de presentar una complicación coronaria y/o cerebrovascular y, por tanto, candidato a recibir un tratamiento preventivo enérgico. La medición del ITB se recomienda en los pacientes mayores de 50 años con varios factores de riesgo vascular, fundamentalmente en aquellos con un riesgo cardiovascular intermedio estimado según las ecuaciones habituales de riesgo

Atherosclerosis is a systemic and progressive disease clinically manifested by the presence of coronary, cerebrovascular or peripheral artery disease. Subjects with atherosclerosis in one vascular bed are at high risk of future vascular complications in a different territory. Ankle-brachial index (ABI) is a straightforward and non-invasive method, with a high sensibility and specificity for the diagnosis of lower limb arterial disease. An ABI below 0,9 identifies a high risk individual, with an elevated probability of coronary and/or cerebrovascular events and so, candidate for agressive preventive measures. ABI measurement is recommeded in all subjects older than 50 years and with multiple cardiovascular risks factors, mainly those with an intermediate risk according to traditional risk ecuations

[Ankle-brachial index in patients with diabetes mellitus: prevalence and risk factors]. / Indice tobillo-brazo en pacientes con diabetes mellitus: prevalencia y factores de riesgo.

INTRODUCTION: Diabetic patients have a high cardiovascular morbidity and mortality rate. Ankle brachial index (ABI) is an available, straightforward and reproducible method for the detection of peripheral vascular disease and for improving risk stratification in this population. The objective of our study was to evaluate the prevalence of a low and a pathological ABI in type 2 diabetics older than 60 years and to study the risk factors associated with its development. PATIENTS AND METHODS: 1,360 subjects between 60 and 79 years, 213 of them diabetics, without symptoms of intermittent claudication and who gave their consent to have an ABI measurement in their primary care center were included in the study. Cardiovascular risk factors were evaluated in all participants. An ABI < 0.9 was considered low and a value < 0.9, >or= 1.4 or non-compressible was considered pathological. RESULTS: Prevalence of a low ABI in subjects with or without diabetes was 11.3% and 4.3% and prevalence of a pathological ABI was 18.8% and 7%, respectively. Factor associated with a low or pathological ABI were gender, age, duration of diabetes, the type of antidiabetic treatment and the presence of vascular disease in another vascular bed. After multivariate adjustment, only age (OR: 1.15; 95% CI: 1.04-1.27) and duration of diabetes (OR: 1.05; 95% CI: 1.01-1.10) continue being significant. The prevalence of a pathological ABI did not differ between diabetics without vascular disease and non-diabetics with previous cardiovascular disease. CONCLUSION: The prevalence of a low or pathological ABI is elevated in diabetic subjects and relates with age, duration of diabetes and the presence of vascular disease in another vascular bed.

Índice tobillo-brazo en pacientes con diabetes mellitus: prevalencia y factores de riesgo / Ankle-brachial index in patients with diabetes mellitus: prevalence and risk factors

Introducción. Los pacientes diabéticos presentan una elevada morbimortalidad cardiovascular. El índice tobillo-brazo (ITB) es un método sencillo, barato y reproducible para detectar la existencia de enfermedad vascular periférica y mejorar la estratificación del riesgo cardiovascular en esta población. El objetivo de nuestro estudio fue evaluar la prevalencia de un ITB bajo y de un ITB patológico en pacientes diabéticos tipo 2 mayores de 60 años y conocer los factores que se asocian con su presencia. Pacientes y métodos. Fueron estudiados 1.360 sujetos de entre 60 y 79 años de edad, 213 de ellos diabéticos, sin clínica de claudicación intermitente, que accedieron de forma voluntaria a realizarse un ITB en su Centro de Salud. A todos ellos se les determinaron sus factores de riesgo cardiovascular. Se consideró un ITB bajo a un valor < 0,9 y un ITB patológico a un valor < 0,9, ≥ 1,4 o incompresible. Resultados. La prevalencia de un ITB bajo en pacientes con y sin diabetes fue del 11,3% y del 4,3% y la de un ITB patológico del 18,8% y del 7%, respectivamente. Los factores que se asociaron con un ITB bajo o patológico en la población diabética fueron el sexo, la edad, los años de evolución de la diabetes, el tratamiento antidiabético recibido y la presencia o no de enfermedad vascular en otro territorio. En el análisis multivariante sólo la edad (OR: 1,15; IC 95%: 1,04-1,27) y los años de evolución de la diabetes (OR: 1,05; IC 95%: 1,01-1,10) permanecieron significativos. La prevalencia de un ITB patológico fue similar en sujetos diabéticos sin enfermedad cardiovascular que en pacientes no diabéticos con enfermedad cardiovascular previa. Conclusión. La prevalencia de un ITB bajo o patológico es elevada en los pacientes diabéticos, siendo dependiente de la edad, los años de evolución de la diabetes y la presencia de enfermedad vascular a nivel coronario o cerebral (AU)

Introduction. Diabetic patients have a high cardiovascular morbidity and mortality rate. Ankle brachial index (ABI) is an available, straightforward and reproducible method for the detection of peripheral vascular disease and for improving risk stratification in this population. The objective of our study was to evaluate the prevalence of a low and a pathological ABI in type 2 diabetics older than 60 years and to study the risk factors associated with its development. Patients and methods. 1,360 subjects between 60 and 79 years, 213 of them diabetics, without symptoms of intermittent claudication and who gave their consent to have an ABI measurement in their primary care center were included in the study. Cardiovascular risk factors were evaluated in all participants. An ABI < 0.9 was considered low and a value < 0.9, ≥ 1.4 or non-compressible was considered pathological. Results. Prevalence of a low ABI in subjects with or without diabetes was 11.3% and 4.3% and prevalence of a pathological ABI was 18.8% and 7%, respectively. Factor associated with a low or pathological ABI were gender, age, duration of diabetes, the type of antidiabetic treatment and the presence of vascular disease in another vascular bed. After multivariate adjustment, only age (OR: 1.15; 95% CI: 1.04-1.27) and duration of diabetes (OR: 1.05; 95% CI: 1.01-1.10) continue being significant. The prevalence of a pathological ABI did not differ between diabetics without vascular disease and non-diabetics with previous cardiovascular disease. Conclusion. The prevalence of a low or pathological ABI is elevated in diabetic subjects and relates with age, duration of diabetes and the presence of vascular disease in another vascular bed (AU)

[Multiple paraganglioma: careful with surgery!]. / Paraganglioma multicéntrico: cuidado con la cirugía.

INTRODUCTION: Extraadrenal paragangliomas are exceptional tumors. They prevail the carotid, jugulotympanic, and vagal ones. They are frequently multiple and its treatment is controversial in view of the fact that bilateral removal can go with severe morbidity. The case of a patient with bilateral paraganglioma and postoperative baroreflex dysfunction with severe arterial hypertension and hypotension episodes is presented. CLINICAL OBSERVATION: A 23-year-old woman with a diagnosis of left carotid and right vagal paraganglioma by TC and angiography. In January 1999 the left carotid paraganglioma was operated. The patient showed dysphonia, dysphagia, and lingual dysmotility in the postoperative course, with spontaneous improvement after some months. In December 1999, after the removal of the right vagal paraganglioma, the same complications appeared and hypertension crises (230/140), associated with headache, dizziness, and rash, and alternating with severe hypotension episodes (70/50). Blood biochemistry and the levels of cortisol, thyroid hormones, catecholamines, and metabolites were normal. Imaging techniques discarded tumor at another level and the registry of the ambulatory monitoring of blood pressure (AMBP) confirmed an important pressure lability. The neurophysiological study of the autonomous nervous system demonstrated the failure of the fast regulation mechanisms of the blood pressure. With the diagnosis of baroreceptors dysfunction and paralyses of cranial nerves IX, X and XII a treatment with clonidine was started with poor tolerability and incomplete response. DISCUSSION: This case illustrates the treatment difficulties of paragangliomas, especially when they are bilateral, and in which the surgery can go with severe morbidity. Baroreflex dysfunction should be entertained in the differential diagnosis of the extreme pressure lability.

Paraganglioma multicéntrico: cuidado con la cirugía / Multiple paraganglioma: careful with surgery!

Introducción. Los paragangliomas extraadrenales son tumores excepcionales. Predominan los carotídeos, yugulotimpánicos y vagales. Con frecuencia son múltiples y su tratamiento es motivo de controversia dado que la extirpación bilateral puede acompañarse de importante morbilidad. Se presenta el caso de una paciente con paraganglioma bilateral y disfunción barorrefleja posquirúrgica que le ocasionaba crisis de hipertensión e hipotensión arterial severas. Observación clínica. Mujer de 23 años diagnosticada de paraganglioma carotídeo izquierdo y vagal derecho por tomografía computarizada (TC) y angiografía. En enero de 1999 fue intervenida del paraganglioma carotídeo izquierdo. En el postoperatorio presentó disfonía, disfagia y dismotilidad lingual, con mejoría espontánea en unos meses. En diciembre de 1999, tras la extirpación del paraganglioma vagal derecho, presentó las mismas complicaciones y crisis de hipertensión arterial (230/140 mmHg) acompañadas de cefalea, mareo y rash, alternando con episodios de hipotensión severa (70/50 mmHg).La analítica general y las determinaciones de cortisol, hormonas tiroideas, catecolaminas y metabolitos fueron normales. Las pruebas de imagen descartaron tumor a otro nivel y el registro de la monitorización ambulatoria de presión arterial (MAPA) confirmó una importante labilidad tensional. El estudio neurofisiológico del sistema nervioso autónomo demostró fallo de los mecanismos de regulación rápida de la tensión arterial. Con el diagnóstico de disfunción de barrorreceptores y parálisis de pares craneales IX, X y XII se inició tratamiento con clonidina con mala tolerancia y respuesta incompleta. Discusión. La paciente ilustra la dificultad de tratar los paragangliomas, especialmente si son bilaterales, en los cuales la cirugía puede ocasionar una morbilidad importante. La disfunción del barorreflejo debe ser considerada en el diagnóstico diferencial de la labilidad tensional extrema (AU)

[Acute myocardial infarction secondary to Wegener's granulomatosis]. / Infarto agudo de miocardio secundario a granulomatosis de Wegener.

Wegener's granulomatosis (WG) is a necrotizing and granulomatous vasculitis that usually affects the upper and lower respiratory tract and the kidneys. Cardiac involvement is rare although pericarditis, coronary arteritis, myocarditis, valvulitis and arrhythmias have been described. Acute myocardial infarction with clinical expression is an exceptional complication of Wegener's granulomatosis. We report a case of a 30-year-old man with Wegener's granulomatosis who suffered an acute myocardial infarction during the initial phase of the disease, following seven days of treatment with glucocorticoids and cyclophosphamide. Transthoracic echocardiography showed abnormal regional wall motion with septal hypokinesia and apical akinesia. Cardiac catheterization revealed an ectasic segment in the proximal left anterior descending coronary artery and total occlusion in the mid-segment. Medical therapy with prednisone and cyclophosphamide was continued. No complications and initial remission were achieved.