Prevalencia de dislipemia aterogénica, factores relacionados y grado de control lipídico en la población general de Galicia. Estudio GALIPEMIAS / Prevalence of atherogenic dyslipidemia, related factors and level of lipid control in the general population of Galicia. GALIPEMIAS study

Objetivos: GALIPEMIAS es un estudio diseñado para establecer la prevalencia de las dislipemias familiares en la población general de Galicia. El objetivo del presente estudio fue determinar la prevalencia de dislipemia aterogénica (DA), su relación con otros factores de riesgo cardiovascular (RCV) y el grado de control lipídico. Métodos: Estudio transversal realizado en la población general mayor de 18 años de edad residente en Galicia, y con tarjeta sanitaria del Servicio Gallego de Salud (N=1.000). Selección de la muestra mediante muestreo aleatorizado por conglomerados. Se analizó la prevalencia de DA ajustada por edad y sexo, y las variables relacionadas. Resultados: La prevalencia de DA ajustada por edad y sexo fue de un 6,6% (IC 95%: 5,0-8,3). La hipertensión arterial, la glucemia basal alterada, la diabetes mellitus tipo 2 y la enfermedad cardiovascular aterosclerótica fueron más frecuentes en individuos con DA que en el resto de la población. El 47,5% de los sujetos con DA presentaba un RCV alto o muy alto. Recibían fármacos hipolipemiantes el 38,9% (30,5% estatinas) de los participantes con DA (46,1% de los de alto y el 71,4% de los de muy alto RCV). El 25,4% de los sujetos con DA presentaban niveles de cLDL en objetivo, siendo todos ellos de bajo o moderado RCV. Conclusiones: La prevalencia de DA en la población general adulta de Galicia no es despreciable, se relacionó con varios factores de RCV y la enfermedad cardiovascular aterosclerótica. A pesar de ello, estuvo infradiagnosticada e infratratada.(AU)

Objectives: GALIPEMIAS is a study designed to establish the prevalence of familial dyslipidemia in the general population of Galicia. The objective of the present study was to assess the prevalence of atherogenic dyslipidemia (AD), its relationship with other cardiovascular risk (CVR) factors, and the degree of lipid control. Methods: Cross-sectional study carried out in the general population over 18 years of age residing in Galicia and with a health card from the Galician Health Service (N=1,000). Selection of the sample by means of random sampling by conglomerates. The AD prevalence adjusted for age and sex and the related variables were analyzed. Results: The prevalence of AD adjusted for age and sex was 6.6% (95% CI: 5.0-8.3%). Arterial hypertension, altered basal glycemia, type 2 diabetes mellitus and cardiovascular disease were more frequent in subjects with AD than in the rest of the population. 47.5% of the subjects with AD had a high or very high CVR. Lipid-lowering drugs were received by 38.9% (30.5% statins) of the participants with AD (46.1% of those with high and 71.4% of those with very high CVR). 25.4% of the subjects with AD had target LDL-c levels, all of them with low or moderate CVR. Conclusions: The prevalence of AD in the general adult population of Galicia is not negligible, and it was related to several CVR factors and cardiovascular disease. Despite this, this lipid alteration was underdiagnosed and undertreated.(AU)

Prevalence of atherogenic dyslipidemia, related factors and level of lipid control in the general population of Galicia. GALIPEMIAS study. / Prevalencia de dislipemia aterogénica, factores relacionados y grado de control lipídico en la población general de Galicia. Estudio GALIPEMIAS.

OBJECTIVES: GALIPEMIAS is a study designed to establish the prevalence of familial dyslipidemia in the general population of Galicia. The objective of the present study was to assess the prevalence of atherogenic dyslipidemia (AD), its relationship with other cardiovascular risk (CVR) factors, and the degree of lipid control. METHODS: Cross-sectional study carried out in the general population over 18 years of age residing in Galicia and with a health card from the Galician Health Service (N=1,000). Selection of the sample by means of random sampling by conglomerates. The AD prevalence adjusted for age and sex and the related variables were analyzed. RESULTS: The prevalence of AD adjusted for age and sex was 6.6% (95% CI: 5.0-8.3%). Arterial hypertension, altered basal glycemia, type 2 diabetes mellitus and cardiovascular disease were more frequent in subjects with AD than in the rest of the population. 47.5% of the subjects with AD had a high or very high CVR. Lipid-lowering drugs were received by 38.9% (30.5% statins) of the participants with AD (46.1% of those with high and 71.4% of those with very high CVR). 25.4% of the subjects with AD had target LDL-c levels, all of them with low or moderate CVR. CONCLUSIONS: The prevalence of AD in the general adult population of Galicia is not negligible, and it was related to several CVR factors and cardiovascular disease. Despite this, this lipid alteration was underdiagnosed and undertreated.

Beneficios de la urea oral en pacientes con hiponatremiae insuficiencia cardiaca / Benefits of oral urea in patients with hyponatremia and heart failure

Objectives: To assess the efficacy and safety of oral urea in patients with hyponatremia and heart failure (HF).Methods and Results: This is a retrospective observational study of hospitalized and non-hospitalized patients with HF and hyponatremia(serum Na+ < 135 mEq/L) followed by the Heart Failure Unit between January 2013 and May 2018. The study evaluated sodium normalization levels (Na+ = 135 ± 3 mEq/L) after treatment with oral urea. Thirty-four patients were included in the study, and all were on standardtreatment for HF. Natremia at the beginning of treatment with oral urea was 126.34 ± 5.41 mEq/L, and the mean on the day of normalizationwas 136.45 ± 3.22 mEq/L (p < 0.001). The mean time to achieve sodium normalization was 4.28 ± 2.37 days. Blood urea at the beginning oftreatment with urea was 85.77 ± 50.51 mg/dl, and the mean on the day of Na+ normalization was 137.90 ± 56.66 mg/dl (p < 0.001). Therewas an increase in diuresis (p < 0.006) and plasma osmolarity (p < 0.001) as well as a slight decrease in serum potassium (p < 0.001). Themean dose of oral urea was 22.5 g/day. There were no important adverse effects, nor were there significant changes in creatinine levels orthe estimated glomerular filtration rate by the MDRD formula.Conclusions: When added to the standard treatment for short periods of time, treatment with oral urea is safe and effective at correctingnatremia and improving diuresis in patients with hypervolemic HF with hyponatremia. (AU)

Benefit of tolvaptan in the management of hyponatraemia in patients with diuretic-refractory congestive heart failure: the SEMI-SEC project.

AIMS: Hyponatraemia is an electrolyte disorder that occurs in advanced congestive heart failure (HF) and worsens prognosis. We explored the usefulness of tolvaptan, which has shown promising results in the treatment of this condition. METHODS AND RESULTS: This study is based on a retrospective national registry (2011-15) of patients hospitalized with refractory HF and hyponatraemia who agreed to receive tolvaptan when standard treatment was ineffective. The benefit of tolvaptan was analysed according to the following criteria: normalization ([Na+] ≥ 135 mmol/L) or increased sodium levels [Na+] ≥ 4 mEq/L on completion of treatment, and increase in urine output by 300 or 500 mL at 48 h. Factors associated with tolvaptan benefit were explored. A total of 241 patients were included, 53.9% of whom had ejection fraction <40%. All patients received concomitant loop diuretics. Initial tolvaptan dose was 17.2 ± 6.1 mg, and end dose was 26.4 ± 23.2 mg (duration 7.8 ± 8.6 days). Serum sodium concentrations increased significantly at 24-48 h, from 126.5 ± 6.2 mEq/L at baseline to 134.1 ± 6.1 mEq/L at the end of treatment (P < 0.0001). Weight fell by ~5 kg before discharge (P < 0.0001) and urine output increased 1.3-fold (P < 0.0001). Normal sodium levels and/or increases of 500 mL in urine output were achieved by 90.8% of patients (35.7% achieved both) and 94.8% increased to [Na+] ≥ 4 mEq/L and/or +300 mL in urine output (54.4% both). CONCLUSIONS: An increase in sodium levels and/or improvement in urine output was observed in patients admitted for HF and refractory hyponatraemia under tolvaptan treatment. Tolvaptan may be useful in this setting, in which no effective proven alternatives are available.

Enfermedad pulmonar obstructiva crónica en pacientes ingresados por insuficiencia cardiaca. Resultados del Grupo para el Estudio y Significado de la Anemia en la Insuficiencia Cardiaca (GESAIC) / Chronic obstructive pulmonary disease on inpatients with heart failure. GESAIC study results

Fundamento y objetivo: La relevancia clínica de la insuficiencia cardiaca (IC) y de la enfermedad pulmonar obstructiva crónica (EPOC) en un mismo enfermo no está bien establecida. El objetivo de este trabajo fue estudiar la prevalencia de EPOC en pacientes ingresados por IC, definir su perfil clínico y la relación con el tratamiento con bloqueadores beta. Pacientes y método: Análisis de una cohorte prospectiva de pacientes ingresados en 15 servicios de Medicina Interna desde octubre de 2005 hasta marzo de 2006. El diagnóstico de EPOC se estableció por criterios clínicos o espirometría. Se recogieron datos sobre el tratamiento neurohormonal antes, durante y tras el ingreso hospitalario. Se utilizó la prueba de ji al cuadrado y la t de Student. Con las variables significativas se construyó un modelo de regresión logística. En todos los casos se consideró una significación bilateral para p<0,05. Resultados: Se incluyó a 391 pacientes, con una prevalencia de EPOC del 25,1%. En dos tercios de los pacientes se estableció el diagnóstico solo por criterios clínicos. El 23,5% de los enfermos tenía un estadio moderado o grave de EPOC. En el analisis bivariante se relacionó la presencia de EPOC con el sexo masculino (p<0,05), mayor índice de Charlson y mayor sobrepeso (p=0,04 ambos). En el tratamiento con bloqueadores beta adrenérgicos, solo la fracción de eyección del ventrículo izquierdo (p=0,03) y el tratamiento previo (p<0,001) tuvieron significación estadística en el modelo de regresión logística. La prescripción de betabloqueadores en el alta fue del 27,6%. Conclusiones: La prevalencia de EPOC es elevada en IC, y el perfil es el de un hombre de edad avanzada, con elevada comorbilidad y sobrepeso. El tratamiento con betabloqueadores se condiciona por el deterioro de la función ventricular, sin relación con la EPOC

Background and objective: The clinical relevance of Heart failure (HF) and chronic obstructive pulmonary disease (COPD) in the same patient is not well established. We decided to study the prevalence of COPD in patients admitted due to HF, to define their clinical profile and the relationship with adrenergic beta-blockers (BB) treatment. Patients and method: Prospective cohort of inpatients with HF admitted in 15 Internal Medicine Services from October 2005 to March 2006. Diagnosis of COPD was established according to clinical criteria or spirometry. Data about neurohormonal treatment (before, during the admission, and at discharge) were collected. Statistical analyses were performed using Ji square test and T Student test. A logistic regression model was designed with data. P<0.05 being considered statistically significant. Rokesults: About 391 patients were included . CPOD was present in 25.1% of patients. In two thirds of patients, the COPD diagnosis was established by clinical criteria. Regarding GOLD, 23.5% of patients had moderate or severe COPD severity. Bivariate analysis showed that male (<0.05), poor Charlson's Index and overweight (p=0.04 both) had all relationship with COPD. The regression model indicated that only left ventricular ejection fraction (LVEF) and BB treatment before admission had statistical significance (p=0.03 and p<0.001 respectively). At discharge, 27,6% of patients received BB. Conclusions: COPD in HF patients is common and most frequent patients are aged men high comorbidity and overweight. BB treatment is conditioned by LVEF, without relationship with COPD severity (AU)

[Chronic obstructive pulmonary disease on inpatients with heart failure. GESAIC study results]. / Enfermedad pulmonar obstructiva crónica en pacientes ingresados por insuficiencia cardiaca. Resultados del Grupo para el Estudio y Significado de la Anemia en la Insuficiencia Cardiaca (GESAIC).

BACKGROUND AND OBJECTIVE: The clinical relevance of Heart failure (HF) and chronic obstructive pulmonary disease (COPD) in the same patient is not well established. We decided to study the prevalence of COPD in patients admitted due to HF, to define their clinical profile and the relationship with adrenergic beta-blockers (BB) treatment. PATIENTS AND METHOD: Prospective cohort of inpatients with HF admitted in 15 Internal Medicine Services from October 2005 to March 2006. Diagnosis of COPD was established according to clinical criteria or spirometry. Data about neurohormonal treatment (before, during the admission, and at discharge) were collected. Statistical analyses were performed using Ji square test and T Student test. A logistic regression model was designed with data. P<0.05 being considered statistically significant. RESULTS: About 391 patients were included . CPOD was present in 25.1% of patients. In two thirds of patients, the COPD diagnosis was established by clinical criteria. Regarding GOLD, 23.5% of patients had moderate or severe COPD severity. Bivariate analysis showed that male (<0.05), poor Charlson's Index and overweight (p=0.04 both) had all relationship with COPD. The regression model indicated that only left ventricular ejection fraction (LVEF) and BB treatment before admission had statistical significance (p=0.03 and p<0.001 respectively). At discharge, 27,6% of patients received BB. CONCLUSIONS: COPD in HF patients is common and most frequent patients are aged men high comorbidity and overweight. BB treatment is conditioned by LVEF, without relationship with COPD severity.