[Profile of the patient who wants to quick smoking seen in the Primary Care and Specialized consultations in Spain]. / Perfil del paciente que quiere dejar de fumar atendido en consultas de Atención Primaria y especializada de España.

OBJECTIVE: To determine the profile of the smoker who wants to stop smoking. Subjects and methods. A cross-sectional, multicenter study was conducted in 1634 smokers attended by General Practitioners and Specialized Physicians in Spain who had expressed their desire to stop smoking when explicitly asked. Sociodemographic data, background of smoking and related consequences were collected. A descriptive statistical analysis was performed. RESULTS: 67.1% of patients were seen by General Practitioners. Mean age +/- standard deviation was 45.6 +/- 12.0 years old and mean age of onset of usual consumption was 20.6 +/- 7.0. Fifty-six percent of the population studied were men. Most (35.2%) had studied beyond high school and 76.4% were active workers. Seventy-one percent had previously tried to stop smoking (2.7+/- 3.0 mean attempts). Out of 39.2% smokers who had participated in some type of smoking cessation treatment the year before, 70.7% were on substitutive therapy with nicotine. At the time of the visit, 80% admitted they could not stop smoking by themselves. CONCLUSIONS: The profile of the smoker seen in Primary Care and Specialized Consultation in Spain who wants to quit smoking corresponds to a male subject in his 40's, with studies beyond high school, actively working who has made more that two previous attempts to stop smoking, mostly with substitutive therapy with nicotine and who currently believes he is not being able to achieve it by himself.

Tratamientos actuales del tabaquismo: revisión. Necesidades de nuevas vías de abordaje / Current treatments of smoking habit: review. Need for new approaches

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Manejo clínico de los fumadores en proceso de reducción hasta dejarlo. Protocolo clínico / Clinical management of smokers in the process of reducing smoking consumption until giving it up. Clinical Protocol

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Prevalencia de factores de riesgo cardiovascular en la infancia y adolescencia: estudio Carmona / Cardiovascular risk factor prevalence in childhood and adolescence: Carmona study

Introducción. La aparición de enfermedades cardiovasculares en la etapa adulta parece estar determinada por la existencia de factores de riesgo cardiovascular desde edades tempranas del desarrollo. En el presente estudio presentamos las características antropométricas, analíticas e higienicodietéticas de niños de 9 a 17 años de un núcleo urbano de Andalucía. Material y método. Realizamos un estudio observacional transversal en 1.534 niños de primaria y secundaria en colegios de Carmona (Sevilla). Se analizaron el peso, la talla, el índice de masa corporal y las presiones arteriales sistólica y diastólica, además de determinaciones de colesterol total y glucemia capilares de forma estandarizada. Incluimos una encuesta de hábitos higienicodietéticos. Realizamos una comparativa con estudios nacionales e internacionales. Resultados. Los niños estudiados presentaban valores del índice de masa corporal (media ± desviación estándar), de 20,98 ± 3,92, con una prevalencia de obesidad del 7,4%. La presión arterial sistólica fue de 90,5 ± 15,7 y la de la diastólica, de 50,3 ± 11. La concentración media de colesterol total fue de 162,2 ± 17,8 y el de la glucemia, de 73,7 ± 17,2. Se evidenció una correlación directa entre el índice de masa corporal y la presión arterial sistólica (r = 0,3; p < 0,001), que no llegó a la significación estadística con el colesterol y la glucemia. En la alimentación de los niños predominaban las comidas rápidas y los postres ricos en grasas saturadas. Un 70% practicaba ejercicio físico de forma regular. Conclusiones. Los valores del índice de masa corporal se encuentran ligeramente por encima de los registros nacionales, pero con una escasa prevalencia de obesidad infantil. Los valores de colesterol total, presión arterial sistólica y glucemia son comparables a los de ciertas provincias españolas con alta mortalidad cardiovascular, aunque inferiores a los norteamericanos. La dieta de los niños se aleja del patrón mediterráneo, aunque el índice de actividad física es superior al nacional. Por tanto, nuestra muestra representa una población mediterránea que se beneficiaría de medidas de intervención nutricional que corrigiesen los valores del índice de masa corporal

Introduction. The onset of cardiovascular disease in adult hood appears to be determined by the existence of cardiovascular risk factors from early age. The present study presents the anthropometric, analytical and hygiene-dietetic characteristics and their interactions, in children aged 9 to 17 from an urban district of our environment. Material and method. A cross-sectional survey was conducted in 1,534 children from primary and secondary schools in Carmona. Weight, height, body mass index (BMI), systolic and diastolic blood pressure (SBP and DBP); and total cholesterol and capillary glucose levels were evaluated by standardised methods. A survey on hygienie-dietetic habits was included. A comparison was made with national and international studies. Results. The studied children presented BMI values, mean (standard deviation, [SD]) of 20.98 (3.92) with an obesity prevalence of 7.4%. Mean value (SD) of SBP was 90.5 (15.7) and of DBP 50.3 (11). Mean total cholesterol concentration was 162.2 (17.8) and capillary glucose 73.7 (17.2). A direct correlation between BMI and SBP values was demonstrated (r = 0.3; p < 0.001) which did not reach statistical significance with respect to cholesterol and glucose. In children's food, fast food and desserts rich in saturated fats predominated; 70% practised physical exercise regularly. Conclusions. BMI values were slightly above the national registries, but with a low prevalence of infantile obesity. Total cholesterol, blood pressure and glucose values were comparable to those of certain Spanish provinces with high cardiovascular mortality, though lower than those of America. The children's diet moved away from the Mediterranean pattern, although the physical activity index was higher than the national. Therefore, our sample represents a Mediterranean population that would benefit from nutritional intervention which corrects BMI values

La pandemia del tabaquismo / Smoking panepidemic

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Tabaco y enfermedad coronaria / Tobacco and coronary artery disease

El tabaco actúa sinérgicamente con otros factores de riesgo, aumentando sustancialmente el riesgo de enfermedad coronaria, y siguen apareciendo nuevas evidencias de esta relación. Los beneficios de dejar el tabaco se dan incluso en las personas que ya han desarrollado enfermedad coronaria. Cualquier esfuerzo dirigido contra el hábito de fumar merece la pena. La terapia sustitutiva de nicotina se ha mostrado eficaz, y debería estar disponible en los programas de abandono del tabaco. Recientes estudios han mostrado cómo una intervención estatal agresiva lleva a una reducción de muertes por enfermedad coronaria a corto plazo. (AU)

Prevención y tratamiento del tabaquismo en la persona mayor: responsabilidad de todo el personal sanitario en la práctica geriátrica / Prevention of use of tobacco in old people: responsability of every sanitary people

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Tabaco y sistema cardiopulmonar en el anciano / Tobacco and cardiopulmonary risk in the elderly

Los componentes del humo del tabaco producen efectos sobre las plaquetas, endotelio vascular, lipoproteínas, factores hemostáticos y condiciones hemodinámicas, que contribuyen a la aparición de alteraciones cardiovasculares y pulmonares tanto inmediatamente como a largo plazo, y estos efectos perjudiciales se dan también en los ancianos, como lo demuestran recientes estudios epidemiológicos. Las evidencias demuestran varios mecanismos de acción de algunos de los componentes del tabaco (sobre todo de la nicotina y del monóxido de carbono) que contribuyen a este aumento de riesgo. Hay una relación dosis-efecto, y el abandono del tabaquismo conlleva una reducción del riesgo cardiovascular y respiratorio, que puede llegar para algunas enfermedades a niveles similares a los de las personas que nunca han fumado, aunque esto no se ha probado aún en los ancianos (AU)

The components of tobacco smoke produce effects over the platelet, vascular endothelium, lipoproteins, haemostatic factors and haemodinamic conditions wich contribute to the appearence of cardiovascular and pulmonar alterations as inmediately as long term. This negative effects are also given in elderly, as recent epidemiological studies show. The evidences show several action mecanism of some tobacco components (overall nicotine and CO), which contribute to the risk increase. There is a relation dose-effect and the tobacco cesation gives a reduction of cardiovascular and pulmonar risk, which can become similar levels to people who never smoke for some illness (AU)

Randomized comparative trial of triflusal and aspirin following acute myocardial infarction.

AIMS: To compare the efficacy and tolerability of the antiplatelet agent triflusal with aspirin in the prevention of cardiovascular events following acute myocardial infarction. METHODS AND RESULTS: In this double-blind, multicentre, sequential design study, patients were randomized within 24 h of acute myocardial infarction symptom onset to receive triflusal 600 mg or aspirin 300 mg once daily for 35 days. The primary end-point was death, non-fatal myocardial reinfarction or a non-fatal cerebrovascular event. The incidences of these individual outcomes and urgent revascularization were secondary end-points. The null hypothesis of no difference between treatments in the primary combined end-point was accepted with 80% power after recruiting 2124 validated patients (odds ratio (OR) for failure [95% confidence interval (CI)]: 0.882 [0.634-1.227]). Non-fatal cerebrovascular events were significantly less frequent with triflusal (OR [95% CI]: 0.364 [0.146-0.908]; P = 0.030). There was no significant difference between treatments for death (OR [95% CI]: 0.816 [0.564-1.179]; P = 0.278), non-fatal reinfarction (OR [95% CI]: 1.577 [0.873-2.848]; P = 0.131) or revascularization (OR [95% CI]: 0.864 [0.644-1.161]; P = 0.334). Overall, both drugs were well tolerated, although there was a trend towards fewer bleeding episodes with triflusal; significantly fewer central nervous system bleeding episodes were observed in triflusal-treated patients (0.27% vs. 0.97%; P = 0.033). CONCLUSION: Triflusal and aspirin have similar efficacy in preventing further cardiovascular events after acute myocardial infarction, but triflusal showed a more favourable safety profile. Triflusal significantly reduced the incidence of non-fatal cerebrovascular events compared with aspirin.

El tabaco como factor de riesgo cardiovascular. Importancia de la actuación desde la especialidad de cardiología / Tobacco as a cardiovascular risk factor. The importance of an actuation from the speciality of cardiology

Se revisa la "situación actual" del tabaquismo contemplado desde la especialidad de cardiología. El artículo discute la importancia epidemiológica y la relación del tabaquismo con las enfermedades cardiovasculares y de forma resumida, pasa revista a los mecanismos de efecto del tabaco y sus aditivos sobre el aparato cardiovascular, sin olvidar algo tan importante para todos como es el tabaquismo pasivo y la específica acción del tabaco sobre mujeres.En el último apartado se aborda el tratamiento del tabaquismo resaltando la importancia del consejo médico regular, para conseguir abstinencias en un alto porcentaje de pacientes y la forma de intervenir farmacológicamente en los momentos indicados.Se concluye con el mensaje de que estamos ante un reto interesante, en el que a medio plazo se pueden obtener buenos resultados, respecto a la salud pública, pero que requiere implicación sin reservas por parte de los profesionales de la salud y de las instituciones públicas (AU)

El tabaco y sus efectos sobre el sistema cardiovascular / Smoking and its effects on the cardiovascular system

El tabaco es responsable de una parte significativa de la enfermedad y la mortalidad cardiovascular en los países occidentales. Hay numerosos mecanismos que explican este efecto deletéreo: el tabaco crea un perfil lipídico desfavorable, promueve la agregación y la coagulación, induce vasoconstricción y disfunción endotelial, acelera la aterosclerosis, aumenta el tono simpático, y todos estos mecanismos se han demostrado también en el tabaquismo pasivo. Al fumar, las mujeres pierden su 'protección natural' contra la enfermedad cardiovascular.Las formas alternativas de tabaco no ofrecen protección, pues tanto los cigarrillos bajos en nicotina como los cigarros puros han demostrado ser factores de riesgo significativos. Por el contrario, dejar el tabaco es una medida muy protectora, tanto en prevención primaria como secundaria. Es bastante sencillo aconsejar que se deje el tabaco, y ningún fumador debe abandonar nuestra consulta sin oir unas palabras al respecto. Hay al menos dos medidas farmacológicas útiles: los parches de nicotina y el bupropio. Cualquier esfuerzo en promover el abandono del hábito de fumar merece la pena (AU)

[Influence of coronary risk factors in secondary prevention: tobacco]. / Influencia de los factores de riesgo coronario en prevención secundaria: tabaco.

Tobacco smoking is a strong independent factor for atherosclerotic disease, equivalent to hypertension or high cholesterol levels. Middle age people are especially involved, with a mortality rate of about 20% as a consequence of smoking, and a mean loss of life expectancy of 20 years. There is a positive correlation between smoking and severity of atherosclerotic disease in the coronary and cerebral arteries, and the aorta. It has been shown that smoking cessation clearly enhances the prognosis of patients with myocardial infarction. Twice a increase in mortality rate has been found among nonstopping smokers compared with those who stopped smoking eight years after myocardial infarction. In addition, progression of atherosclerosis as shown by angiography is slowed by stopping to smoke. As the coronary risk factors act in a synergistic way, a comprehensive approach to the patient is recommended, especially in smokers with myocardial infarction. It is justified an intensive intervention because of the advantages in this population. The physician should clearly communicate to the patient the need of stopping to smoke, which carries sometimes as beneficial effects as other interventions. A wise use of replacement therapy with transdermal nicotine, together with other useful measures, allows us to manage patients with a broad margin of safety, especially in coronary patients, who win most benefit from ceasing to smoke.

Magnesium sulphate for torsade de pointes in a patient with congenital long QT syndrome.

A young woman with congenital long QT syndrome presented with repetitive torsade de pointes. A single bolus of magnesium sulphate abolished the arrhythmia.

Adverse effect of sodium nitroprusside 48 hours after myocardial infarction.

We present a patient with acute myocardial infarction in whom the use of nitroprusside 48 hours after the first symptom, was accompanied by a rise in the ST segment representative of the ischemic area. Our experience suggests that precaution is needed in the use of nitroprusside even several days after an acute myocardial infarction.

[Fatal acute myocardial infarct in a 14-year old boy]. / Infarto agudo de miocardio letal en un joven de 14 años.

The case of a 14 year old male, with no personal or family antecedents of ischemic heart disease, who died owing to an acute myocardial infarct into the few hours of beginning to pain. In the necroscopic study it was observed that the coronary arteries did not show any anatomical alterations or stenosis from their origins, although a microscopic study revealed extensive zones of necrosis.