Long term clinical outcomes in survivors after out-of-hospital cardiac arrest.

INTRODUCTION AND OBJECTIVES: Information regarding long-term outcomes in patients surviving out-of-hospital cardiac arrest (OHCA) is scarce. Our aim was to study the long-term clinical outcomes of a large cohort of OHCA patients surviving until hospital discharge and to identify predictors of mortality and cardiovascular events. METHODS: Consecutive OHCA patients admitted in the Acute Cardiac Care Unit who survived at least until hospital discharge between 2007 and 2019 were included. All received therapeutic hypothermia according to the local protocol. Pre- and intra-hospital clinical and analytical variables were analyzed, as well as the clinically relevant events during follow-up. RESULTS: A total of 201 patients were included, with a mean age of 57.6 ± 14.2 years, 168 (83.6%) were male. Thirty-six (17.9%) died during a median follow-up of 40.3 months (18.9-69.1), the most frequent causes of death being cardiovascular and neurological, followed by cancer. We calculated a predictive model for mortality during follow-up using Cox regression that included the following variables: poor neurological outcome [HR 3.503 (1.578-7.777)], non-shockable rhythm [HR 2.926 (1.390-6.163)], time to onset of CPR [HR 1.063 (0.997-1.134)], older age [1.036 (1.008-1.064)) and worse ejection fraction at discharge [1.033 (1.009-1.058)]. CONCLUSIONS: Even though few patients experience recurrent cardiac arrest events, survivors after OHCA face high morbidity and mortality during long-term follow-up. Therefore, they may benefit from multidisciplinary teams providing an integral management and ensuring continuity of care.

Dataset regarding baseline and follow-up characteristics of out-of-hospital cardiac arrest patients focused on neurological outcomes.

This data article contains the data related to the research article entitled "Long-term neurological outcomes in out-of-hospital cardiac arrest patients treated with targeted-temperature management" (Caro-Codón et al., 2018). In this dataset, we report details regarding the flow chart of the included patients and the specific exclusion criteria. We also include information on the difference between the patients who attended the structured personal interview (and therefore were finally included in the study) and those who did not attend. Neuropsychiatric and functional data before and after cardiac arrest are also reported. Finally, we list all the "de novo" focal neurological deficits identified after cardiac arrest in the related population.

Long-term neurological outcomes in out-of-hospital cardiac arrest patients treated with targeted-temperature management.

BACKGROUND: This study aimed to assess long-term cognitive and functional outcomes in out-of-hospital cardiac arrest (OHCA) patients treated with targeted-temperature management, investigate the existence of prognostic factors that could be assessed during initial admission and evaluate the usefulness of classic neurological scales in this clinical scenario. METHODS: Patients admitted due to OHCA from August 2007 to November 2015 and surviving at least one year were included. Each patient completed a structured interview focused on the collection of clinical, social and demographic data. All available information in clinical records was reviewed and a battery of neurocognitive and psychometric tests was performed. RESULTS: Seventy-nine patients were finally included in the analysis. Forty-three patients (54.4%) scored below the usual cut-off points for the diagnosis of mild cognitive impairment, even though most of these deficits went unnoticed when patients were assessed using CPC and modified Rankin scale. Nineteen (24%) developed certain degree of impairment in their attention capacity and executive functions. A significant proportion developed new memory-related disorders (43%), depressive symptoms (17.7%), aggressive/uninhibited behavior (12.7%) and emotional lability (8.9%). A greater number of weekly hours of intellectual activity and a qualified job were independent protective factors for the development of cognitive impairment. However, being older at the time of the cardiac arrest was identified as a poor prognostic factor. CONCLUSIONS: There is a high prevalence of long-term cognitive deficits and functional limitations in OHCA survivors. Most commonly used clinical scales in clinical practice are crude and lack sensitivity to detect most of these deficits.

Absceso anular en la endocarditis por microorganismo del grupo HACEK / Annular abscess in HACEK infective endocarditis

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Budgetary Impact Analysis of Reimbursement Varenicline for the Smoking-Cessation Treatment in Patients with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease or Type-2 Diabetes Mellitus: A National Health System Perspective.

AIMS: The study aimed to assess the budgetary impact (BI) of reimbursing varenicline in patients with chronic obstructive pulmonary disease (COPD), type-2 diabetes mellitus (t2-DM) or cardiovascular diseases (CVD). METHODS: The BI was estimated comparing the current non-reimbursed scenario versus a projected reimbursed scenario using the Spanish National Health System (SNHS) perspective. A hybrid model was developed using epidemiological data and Markov chains to estimate smoking cessation rates with varenicline during a 5-year horizon. Costs of cessation were considered in the reimbursement scenario only. Efficacy, expressed as a 1-year continuous abstinence rate, was derived from clinical trials. Cost savings due to smoking cessation were extracted from local cost-of-illness studies. Results are shown as incremental cost savings. Univariate sensitivity analysis was also applied. RESULTS: A total of 68,684 patients stopped smoking in the reimbursed scenario compared with 15,208 without reimbursement. In the reimbursed scenario, total savings accounted for €36.3 million, showing 14.6 million accumulated additional savings compared with the scenario without reimbursement. Sensitivity analyses showed results to be robust with monetary savings starting in the third year of modeling. CONCLUSION: Reimbursement of varenicline in smoking cessation is a cost-effective health policy in the SNHS in COPD, t2-DM or CVD, and could produce cost savings starting in the third year of implementation.

Percutaneous balloon mitral valvuloplasty and closure of the left atrial appendage: Synergy of two procedures in one percutaneous intervention.

Mitral stenosis (MS) is frequently associated with the development of atrial fibrillation (AF) as a consequence of hemodynamic and inflammatory changes in the left atrium. Both conditions predispose to thrombus formation, with frequent involvement of the left atrial appendage (LAA), and consequent increase in the incidence of systemic thromboembolic events. Percutaneous mitral valvuloplasty (PMV) reduces the risk of thromboembolism in patients with significant mitral stenosis. Percutaneous LAA closure is also associated with a reduction in thromboembolic risk in patients with AF, but there are no data regarding the use of this technique in patients with significant mitral valve disease. We report the case of a 57-year-old-woman with significant MS and permanent AF, in New York Heart Association functional class II, who despite adequate oral anticoagulation with acenocoumarol, presented several clinical episodes of systemic thromboembolism in the last four years. It was decided to perform a combined percutaneous procedure, including both PMV and percutaneous LAA closure with the Amplatzer Cardiac Plug device. No significant acute complications occurred and the patient was discharged on indefinite treatment with acenocoumarol associated with aspirin 100 mg/d for three months. After a one-year follow-up, there have been no new embolic episodes or other complications.

El cardiólogo ante el cigarrillo electrónico / Cardiologists and electronic cigarettes

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Novedades en cardiología: riesgo vascular y rehabilitación cardiaca / Update in cardiology: vascular risk and cardiac rehabilitation

El conocimiento en las aéreas de riesgo vascular y rehabilitación, como en otras, se enriquece constantemente. Esta revisión aborda las novedades en los campos de la epidemiología, terreno que muestra lo lejos que se está´ de alcanzar un buen control de los factores de riesgo: en alimentación y nutrición, donde se hace patente la creciente obesidad de una sociedad que consume mal y en exceso; en ejercicio, donde tan difícil es lograr el equilibrio entre beneficio y riesgo, aunque se están haciendo esfuerzos de sistematización; en tabaquismo, donde lo nuevo se centra en programas y políticas, a´ rea en que el cigarrillo electrónico aparece más como problema que como solución; en lípidos, donde el debate transatlántico entre guías se erige como paradigma de divergencia de criterio en un aspecto profundamente estudiado; en hipertensión, donde la alternativa no farmacológica (la denervación renal) ha visto surgir el contratiempo del SYMPLICITY HTN-3, lo que obliga a un replanteamiento en profundidad; en diabetes mellitus, donde los nuevos fármacos inhibidores de la dipeptidil peptidasa-4 y del cotransportador sodio-glucosa tipo 2 y análogos del péptido similar al glucagon tipo 1 aportan mucha información nueva y anticipan la que está por llegar, y en rehabilitación cardiaca, que las nuevas tecnologías de información y comunicación siguen enriqueciendo y con la cual la enfermedad más avanzada, como insuficiencia cardiaca, no es óbice para obtener beneficio. Se finaliza con las novedades en el paciente anciano, al que se aplican los mismos criterios que se extrapolan de los más jóvenes, cuando la presente revisión establece que no debe ser asý (AU)

As in other fields, understanding of vascular risk and rehabilitation is constantly improving. The present review of recent epidemiological update shows how far we are from achieving good risk factor control: in diet and nutrition, where unhealthy and excessive societal consumption is clearly increasing the prevalence of obesity; in exercise, where it is difficult to find a balance between benefit and risk, despite systemization efforts; in smoking, where developments center on programs and policies, with the electronic cigarette seeming more like a problem than a solution; in lipids, where the transatlantic debate between guidelines is becoming a paradigm of the divergence of views in this extensively studied area; in hypertension, where a nonpharmacological alternative (renal denervation) has been undermined by the SYMPLICITY HTN-3 setback, forcing a deep reassessment; in diabetes mellitus, where the new dipeptidyl peptidase-4 and sodium-glucose cotransporter type 2 inhibitors and glucagon like peptide 1 analogues have contributed much new information and a glimpse of the future of diabetes treatment, and in cardiac rehabilitation, which continues to benefit from new information and communication technologies and where clinical benefit is not hindered by advanced diseases, such as heart failure. Our summary concludes with the update in elderly patients, whose treatment criteria are extrapolated from those of younger patients, with the present review clearly indicating that should not be the case (AU)

Update in cardiology: vascular risk and cardiac rehabilitation.

As in other fields, understanding of vascular risk and rehabilitation is constantly improving. The present review of recent epidemiological update shows how far we are from achieving good risk factor control: in diet and nutrition, where unhealthy and excessive societal consumption is clearly increasing the prevalence of obesity; in exercise, where it is difficult to find a balance between benefit and risk, despite systemization efforts; in smoking, where developments center on programs and policies, with the electronic cigarette seeming more like a problem than a solution; in lipids, where the transatlantic debate between guidelines is becoming a paradigm of the divergence of views in this extensively studied area; in hypertension, where a nonpharmacological alternative (renal denervation) has been undermined by the SYMPLICITY HTN-3 setback, forcing a deep reassessment; in diabetes mellitus, where the new dipeptidyl peptidase-4 and sodium-glucose cotransporter type 2 inhibitors and glucagon like peptide 1 analogues have contributed much new information and a glimpse of the future of diabetes treatment, and in cardiac rehabilitation, which continues to benefit from new information and communication technologies and where clinical benefit is not hindered by advanced diseases, such as heart failure. Our summary concludes with the update in elderly patients, whose treatment criteria are extrapolated from those of younger patients, with the present review clearly indicating that should not be the case.

Impacto de la legislación que prohíbe fumar en lugares públicos en la reducción de la incidencia de síndrome coronario agudo en España / Laws restricting smoking in public places reduce the incidence of acute coronary syndrome in Spain

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Update in cardiology: vascular risk and cardiac rehabilitation.

Cardiovascular disease develops in a slow and subclinical manner over decades, only to manifest suddenly and unexpectedly. The role of prevention is crucial, both before and after clinical appearance, and there is ample evidence of the effectiveness and usefulness of the early detection of at-risk individuals and lifestyle modifications or pharmacological approaches. However, these approaches require time, perseverance, and continuous development. The present article reviews the developments in 2013 in epidemiological aspects related to prevention, includes relevant contributions in areas such as diet, weight control methods (obesity is now considered a disease), and physical activity recommendations (with warnings about the risk of strenuous exercise), deals with habit-related psychosocial factors such as smoking, provides an update on emerging issues such as genetics, addresses the links between cardiovascular disease and other pathologies such as kidney disease, summarizes the contributions of new, updated guidelines (3 of which have recently been released on topics of considerable clinical importance: hypertension, diabetes mellitus, and chronic kidney disease), analyzes the pharmacological advances (largely mediocre except for promising lipid-related results), and finishes by outlining developments in the oft-neglected field of cardiac rehabilitation. This article provides a briefing on controversial issues, presents interesting and somewhat surprising developments, updates established knowledge with undoubted application in clinical practice, and sheds light on potential future contributions.

Temas de actualidad en cardiología: riesgo vascular y rehabilitación cardiaca / Update in Cardiology: Vascular Risk and Cardiac Rehabilitation

La enfermedad cardiovascular se establece de manera lenta y subclínica durante décadas, para a menudo manifestarse de modo abrupto e inesperado. El papel de la prevención, antes y después de la aparición de la clínica, es capital y existen numerosas pruebas de la eficacia y la eficiencia de las medidas dirigidas a detectar precozmente a los sujetos en riesgo y actuar mediante modificaciones en el estilo de vida o medidas farmacológicas, pero ello exige tiempo, constancia y actualización permanente. Este artículo resume las novedades de 2013 en los aspectos epidemiológicos relacionados con la prevención, incorpora relevantes contribuciones en materias como la dieta, las formas de control del peso (la obesidad ha pasado a ser considerada una enfermedad) y las recomendaciones sobre la actividad física (con advertencias sobre el riesgo del ejercicio extenuante), aborda los factores psicosociales tan relacionados con hábitos como el tabaquismo, actualiza aspectos emergentes como la genética, trata el ligamen de la enfermedad cardiovascular con otras como la renal, resume la aportación de nuevas guías que actualizan las previas (han visto la luz muy recientemente tres de ellas sobre aspectos de gran peso clínico: hipertensión, diabetes mellitus y enfermedad renal crónica) y analiza los avances farmacológicos, ciertamente no espectaculares, pero algunos, como en lípidos, prometedores, para acabar poniendo al día el siempre olvidado campo de la rehabilitación cardiaca. La lectura de esta actualización pone al día temas controvertidos, aporta novedades de interés y algunas sorprendentes, sedimenta viejos conocimientos de indudable aplicación en el ejercicio clínico y abre las puertas a aportaciones de futuro (AU)

Cardiovascular disease develops in a slow and subclinical manner over decades, only to manifest suddenly and unexpectedly. The role of prevention is crucial, both before and after clinical appearance, and there is ample evidence of the effectiveness and usefulness of the early detection of at-risk individuals and lifestyle modifications or pharmacological approaches. However, these approaches require time, perseverance, and continuous development. The present article reviews the developments in 2013 in epidemiological aspects related to prevention, includes relevant contributions in areas such as diet, weight control methods (obesity is now considered a disease), and physical activity recommendations (with warnings about the risk of strenuous exercise), deals with habit-related psychosocial factors such as smoking, provides an update on emerging issues such as genetics, addresses the links between cardiovascular disease and other pathologies such as kidney disease, summarizes the contributions of new, updated guidelines (3 of which have recently been released on topics of considerable clinical importance: hypertension, diabetes mellitus, and chronic kidney disease), analyzes the pharmacological advances (largely mediocre except for promising lipid-related results), and finishes by outlining developments in the oft-neglected field of cardiac rehabilitation. This article provides a briefing on controversial issues, presents interesting and somewhat surprising developments, updates established knowledge with undoubted application in clinical practice, and sheds light on potential future contributions (AU)

Carga económica y social de la enfermedad coronaria / Economic and social burden of coronary heart disease

Desde el punto de vista epidemiológico, la importancia del problema de la cardiopatía isquémica en nuestro entorno es de primera magnitud por frecuencia, consumo de recursos y mortalidad. El aumento de la carga de enfermedad, unido al desarrollo tecnológico, aumenta el coste total. En un escenario de recursos limitados, es necesario administrarlos de la forma más eficiente posible. En España no existe una única agencia consolidada de evaluación de tecnologías sanitarias, y la fijación de precio y reembolso se rige fundamentalmente por criterios de oportunidad. En este artículo se recorre la forma de tomar decisiones clínicas en nuestro entorno y la eficiencia de los medicamentos, pruebas diagnósticas, procedimientos invasivos y dispositivos utilizados en la enfermedad coronaria. Se llama la atención sobre la necesidad de cambiar algunos paradigmas para afrontar de forma eficiente el reto del coste y la carga crecientes de la enfermedad coronaria en los próximos años, con unos recursos previsiblemente escasos. Para sostener nuestro sistema sanitario, los clínicos, los economistas de la salud, las autoridades sanitarias y la industria biomédica tendrían que intentar hablar un lenguaje común y buscar un punto de encuentro (AU)

From an epidemiological point of view, coronary heart disease is a problem of the highest order in Spain because of its prevalence, resource costs and associated mortality. An increase in disease burden combined with technological innovation has led to a rise in the total cost. Today, when resources are limited, it is essential that they are used as efficiently as possible. In Spain, no single agency is responsible for health technology assessment. Consequently, the level of prices and reimbursements is largely determined on an ad hoc basis. In this article, we review the way in which clinical decisions are made in our field and discuss the efficiency of the drugs, diagnostic tests, invasive procedures and medical devices used in coronary heart disease. We also highlight the need to change some treatment paradigms so that we can deal more efficiently with the increasing cost and the growing burden of coronary heart disease in coming years, within the context of predictably scarcer resources. If we are to sustain our health-care system, clinicians, health economists, health-care authorities and the health-care industry all need to learn a common language and find common ground (AU)

Riesgo cardiovascular: evaluación del tabaquismo y revisión en atención primaria del tratamiento y orientación sanitaria. Estudio RETRATOS / Cardiovascular risk in Spanish smokers compared to non-smokers. RETRATOS study

ObjetivoEvaluar el grado de riesgo cardiovascular del paciente fumador frente al del no fumador, que acude a las consultas de atención primaria.DiseñoEstudio epidemiológico observacional, transversal y multicéntrico.EmplazamientoAtención primaria.ParticipantesSe incluyeron de forma consecutiva a los 4 primeros pacientes (3 fumadores y uno no fumador) con edades entre 35-80 años que acudieran a la consulta por cualquier motivo. Se incluyeron 2.184, siendo evaluados 2.124 (1.597 fumadores y 527 no fumadores).MedicionesSe calculó el riesgo de presentar una enfermedad cardiovascular (RECV) mortal a 10 años mediante el modelo Systematic Coronary Risk Evaluation (SCORE), clasificado en muy alto (> 15%), alto (10-14%), ligeramente elevado (5-9%), moderado (3-4%), bajo (2%), muy bajo (1%) y despreciable (< 1%). Se utilizó un modelo de regresión logística para estimar la relación del tabaquismo con eventos cardiovasculares previos.ResultadosEl RECV mortal a 10 años fue superior en los pacientes fumadores (4,0±5,3) frente a los no fumadores (1,9±2,5) (p<0,0001). Estratificación del riesgo: bajo en 78,0% de no fumadores y 60,7% de fumadores (p<0,0001); intermedio en 11,1% de no fumadores y 12,6% de fumadores (p<0001); alto en 10,9% de no fumadores y 26,7% de fumadores (p<000,1). El modelo de regresión logística mostró que los no fumadores tenían menos probabilidad de sufrir infarto de miocardio (OR 0,3; IC 95%:0,1-0,8; p<0,0001), enfermedad vascular periférica (OR 0,6; IC: 0,4-1,0; p=0,0180) y enfermedad pulmonar obstructiva crónica (OR 0,18; IC: 0,1-0,2; p=0,0507).ConclusionesEl tabaco se relaciona con un alto riesgo de enfermedad cardiovascular mortal. Promover activamente desde las consultas de atención primaria medidas orientadas a disminuir la prevalencia de tabaquismo permitiría disminuir la morbilidad y mortalidad cardiovascular(AU)

AimTo evaluate the level of cardiovascular risk in smokers seenin Primary Care clinics.DesignEpidemiologic, cross-sectional and multicentre study.SettingPrimary Care.PatientsEvery investigator included 4 consecutive patients (3 smokers, 1 non-smoker) aged 35-50 years, who came to the clinic for any reason. A total of 2,184 patients were included; 2,124 (1,597 smokers; 527 non-smokers) were evaluated and 60 patients were excluded because they did not meet with selection criteria.MeasurementsThe 10-year risk of suffering from a fatal cardiovascular disease (CVDR) was calculated according to the SCORE (Systematic Coronary Risk Evaluation) model. The 10-year lethal CVR according SCORE model, was classified as: very high (> 15%), high (10-14%), slightly high (5-9%), average (3-4%), low (2%), very low (1%) and negligible (< 1%). A logistical regression model was used to estimate the relationship between smoking and prior cardiovascular events.Results10-year fatal CVDR according to the SCORE model was significantly higher in smokers (40±5.3) vs. non-smokers (1.9±2.5) (P<.0001). Risk stratification: low (< 3%) [78.0% non-smokers vs. 60.7% smokers (P<.0001)]; intermediate (3-5%) [11.1% non-smokers vs. 12.6% smokers (P<.001)]; high (> 5%) [10.9% non-smokers vs. 26.7% smokers (P<.001)]. The logistical regression model showed that non-smokers vs. smokers had less probability of suffering myocardial infarction (OR 0.3; 95% confidence interval (95% CI): 0.1-0.8; P<.0001), peripheral vascular disease (OR 0.6; 95% CI: 0.4-1.0; P=.0180) and chronic obstructive lung disease (OR 0.18; 95% CI: 0.1-0.2; P=.0507).ConclusionsSmoking is related to a high risk of fatal cardiovascular disease.Active promotion in Primary Care clinics of measures aimed at reducing the prevalence of the smoking habit would lead to a lowering of cardiovascular morbidity and mortality(AU)

[Cardiovascular risk in Spanish smokers compared to non-smokers: RETRATOS study]. / Riesgo cardiovascular: evaluación del tabaquismo y revisión en atención primaria del tratamiento y orientación sanitaria. Estudio RETRATOS.

AIM: To evaluate the level of cardiovascular risk in smokers seenin Primary Care clinics. DESIGN: Epidemiologic, cross-sectional and multicentre study. SETTING: Primary Care. PATIENTS: Every investigator included 4 consecutive patients (3 smokers, 1 non-smoker) aged 35-50 years, who came to the clinic for any reason. A total of 2,184 patients were included; 2,124 (1,597 smokers; 527 non-smokers) were evaluated and 60 patients were excluded because they did not meet with selection criteria. MEASUREMENTS: The 10-year risk of suffering from a fatal cardiovascular disease (CVDR) was calculated according to the SCORE (Systematic Coronary Risk Evaluation) model. The 10-year lethal CVR according SCORE model, was classified as: very high (> 15%), high (10-14%), slightly high (5-9%), average (3-4%), low (2%), very low (1%) and negligible (< 1%). A logistical regression model was used to estimate the relationship between smoking and prior cardiovascular events. RESULTS: 10-year fatal CVDR according to the SCORE model was significantly higher in smokers (40±5.3) vs. non-smokers (1.9±2.5) (P<.0001). RISK STRATIFICATION: low (< 3%) [78.0% non-smokers vs. 60.7% smokers (P<.0001)]; intermediate (3-5%) [11.1% non-smokers vs. 12.6% smokers (P<.001)]; high (> 5%) [10.9% non-smokers vs. 26.7% smokers (P<.001)]. The logistical regression model showed that non-smokers vs. smokers had less probability of suffering myocardial infarction (OR 0.3; 95% confidence interval (95% CI): 0.1-0.8; P<.0001), peripheral vascular disease (OR 0.6; 95% CI: 0.4-1.0; P=.0180) and chronic obstructive lung disease (OR 0.18; 95% CI: 0.1-0.2; P=.0507). CONCLUSIONS: Smoking is related to a high risk of fatal cardiovascular disease. Active promotion in Primary Care clinics of measures aimed at reducing the prevalence of the smoking habit would lead to a lowering of cardiovascular morbidity and mortality.

Mortalidad por cualquier causa e incidencia de enfermedad cardiovascular en hipertensos con perfil tipo Anglo-Scandinavian Cardiac Outcomes Trial en un ámbito poblacional español / All-cause mortality and incidence of major cardiovascular events in hypertensive patients with ASCOT-type profile in a Spanish population setting

ObjetivosLas poblaciones mediterráneas se han asociado, tradicionalmente, con incidencias más bajas en enfermedades cardiovasculares (ECV). Sin embargo, este dato no se puede homogeneizar para todo tipo de paciente. El objeto del estudio fue comparar la incidencia en ECV y la mortalidad por cualquier causa en pacientes hipertensos con perfil tipo Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) con el resto de hipertensos.DiseñoAnálisis retrospectivo de una base de datos sanitaria. Pacientes hipertensos sin enfermedad cardiovascular conocida incluidos en el tratamiento antihipertensivo durante el año 2006 se siguieron durante 2 años consecutivos para comprobar la incidencia de muerte y los ECV. Los ECV incluían enfermedad coronaria, infarto agudo de miocardio, angina, ictus, accidente isquémico transitorio y arteriopatía periférica. Los pacientes con el perfil tipo ASCOT y tipo ASCOT-Lipid Lowering Arm (LLA) se identificaron y se compararon con hipertensos sin estos perfiles.ResultadosSe incluyó a un total de 11.104 sujetos en el análisis; edad media de 68,0±11,4 años, el 41,6% varones. Más del 73% de los pacientes reunía criterios para considerarse con perfil tipo ASCOT. Los datos de mortalidad por cualquier causa fueron numéricamente más altos en los pacientes tipo ASCOT y ASCOT-LLA comparados con el resto; razón de tasas (intervalo de confianza del 95%=1,3 [0,8–1,9] y 1,6 [0,9–2,8], respectivamente). Sin embargo, la incidencia de cualquier acontecimiento cardiovascular no mortal fue significativamente más alta tanto en tipo ASCOT como ASCOT-LLA (2,3 [1,8–2,8; p<0,001] y 1,8 [1,3–2,4; p<0,001], respectivamente).ConclusionesLos pacientes hipertensos en tratamiento tipo ASCOT presentan más probabilidades de tener cualquier ECV que los pacientes sin ese perfil en un contexto mediterráneo español(AU)

ObjectivesMediterranean populations are traditionally considered to be associated with lower incidence of cardiovascular events (CVE). However, this might not be homogeneous throughout different patient strata. The goal was to compare the incidence of CVE and all-causes mortality in hypertensive patients with an ASCOT-type profile with that of the rest hypertensive subjects.MethodsA retrospective analysis was carried out using a claim database. Hypertensive patients without known cardiovascular disease on antihypertensive therapy included during year 2006 were followed up for two consecutive years to ascertain the incidence of all-causes mortality and any CVE. CVE included any of the following: coronary heart disease, acute myocardial infarction (AMI), angina, stroke, transient ischemic attack (TIA) and peripheral artery disease. Patients with ASCOT and ASCOT-LLA type profiles were identified and compared with non-ASCOT-type profile hypertensive subjects.ResultsA total of 11,104 were included in the analysis; 68.0±11.4 years, 41.6% males. More than 73% of subjects fulfilled criteria for ASCOT-type profile. All-causes mortality were numerically higher in ASCOT and ASCOT-LLA subjects compared with non-ASCOT-type; hazard ratio (95% CI)=1.3 (0.8–1.9) and 1.6 (0.9–2.8), respectively. However, any-coronary event rate was significantly higher in ASCOT-type [2.3 (1.8–2.8), p<0.001], as well as in ASCOT-LLA subjects [1.8 (1.3–2.4), p<0.001].ConclusionsHypertensive patients on treatment with ASCOT-type profile are more likely to have any cardiovascular event than those hypertensive patients without ASCOT profile in a Mediterranean setting in Spain(AU)

[All-cause mortality and incidence of major cardiovascular events in hypertensive patients with ASCOT-type profile in a Spanish population setting]. / Mortalidad por cualquier causa e incidencia de enfermedad cardiovascular en hipertensos con perfil tipo Anglo-Scandinavian Cardiac Outcomes Trial en un ámbito poblacional español.

OBJECTIVES: Mediterranean populations are traditionally considered to be associated with lower incidence of cardiovascular events (CVE). However, this might not be homogeneous throughout different patient strata. The goal was to compare the incidence of CVE and all-causes mortality in hypertensive patients with an ASCOT-type profile with that of the rest hypertensive subjects. METHODS: A retrospective analysis was carried out using a claim database. Hypertensive patients without known cardiovascular disease on antihypertensive therapy included during year 2006 were followed up for two consecutive years to ascertain the incidence of all-causes mortality and any CVE. CVE included any of the following: coronary heart disease, acute myocardial infarction (AMI), angina, stroke, transient ischemic attack (TIA) and peripheral artery disease. Patients with ASCOT and ASCOT-LLA type profiles were identified and compared with non-ASCOT-type profile hypertensive subjects. RESULTS: A total of 11,104 were included in the analysis; 68.0+/-11.4 years, 41.6% males. More than 73% of subjects fulfilled criteria for ASCOT-type profile. All-causes mortality were numerically higher in ASCOT and ASCOT-LLA subjects compared with non-ASCOT-type; hazard ratio (95% CI)=1.3 (0.8-1.9) and 1.6 (0.9-2.8), respectively. However, any-coronary event rate was significantly higher in ASCOT-type [2.3 (1.8-2.8), p<0.001], as well as in ASCOT-LLA subjects [1.8 (1.3-2.4), p<0.001]. CONCLUSIONS: Hypertensive patients on treatment with ASCOT-type profile are more likely to have any cardiovascular event than those hypertensive patients without ASCOT profile in a Mediterranean setting in Spain.