Guías de prevención cardiovascular de sociedades científicas y administraciones sanitarias: la necesidad de convergencia / Cardiovascular prevention guidelines of the scientific societies and healthcare administrations: the need for convergence

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[Telemedicine, prison and illness associated with HIV]. / Telemedicina, centros penitenciarios y enfermedad por VIH.

OBJECTIVE: Communicate the activity of telemedicine, from its opening, between a hospital consultation of infectious diseases and a penitentiary center. METHODS: Descriptive study of the tele-consultation of infectious diseases of the Alcorcón Foundation University Hospital with the Navalcarnero penitentiary center from 2013 to 2017, which is carried out by videoconference. The reason and number of consultations, diagnosis of HIV, antiretroviral treatment (ART), immunovirological situation, diagnosis of hepatitis C virus (HCV= and intervention performed by the infectious expert were analyzed. RESULTS: A total of 75 patients were evaluated in a total of 168 consultations (in the first year 11 consultations and in the fifth year 62). The index of successive / new consultations was 1.24 and 85% of the patients required less than 1 year of follow-up. 84% of patients did not move to the hospital. 99% of patients accepted this modality. 96% were HIV positive, 94% of them took ART and 85% had undetectable viral load with 532 CD4/mL of medium. 90% had positive serology for HCV. 72% of the consultations were for the assessment of HCV treatment, which was sofosbuvir/ledipasvir by 63%. 40% changed their ART (70% to avoid interactions). CONCLUSIONS: Most of the evaluated patients have HIV infection. This type of consultation has a growing demand, is efficient (avoids transfers and is decisive) and has high acceptance. The most frequent reason for consultation was the treatment of HCV and more than a third of patients required ART change.

¿Hay evidencias de que la elevación del colesterol unido a lipoproteínas de alta densidad obtiene beneficio clínico? / Is there evidence that increasing high-density lipoprotein cholesterol has clinical benefits?

La relación entre valores reducidos de colesterol unido a lipoproteínas de alta densidad (cHDL) y un aumento de riesgo de desarrollo de aterosclerosis es incuestionable desde el punto de vista epidemiológico. La mayoría de los ensayos clínicos ha valorado elevaciones del cHDL sin estudiar los cambios en la funcionalidad de las HDL. Adicionalmente, los fármacos que se han empleado para elevar el cHDL tienen una eficacia limitada, así como efectos secundarios no deseados, pertenecen a grupos farmacológicos heterogéneos con efectos metabólicos variados y, en algunas ocasiones, han mostrado efectos cardiovasculares contraproducentes. Globalmente, puede considerarse que la elevación farmacológica de los valores de cHDL ha producido, hasta ahora, efectos protectores cardiovasculares escasos, muy inferiores a los esperables a partir de los datos epidemiológicos. La importante diana del cHDL necesita nuevas aproximaciones terapéuticas que consigan de modo efectivo una reducción significativa del riesgo vascular (AU)

The association between reduced levels of high-density lipoprotein cholesterol (HDL-c) and an increased risk of the development of atherosclerosis is unquestionable from an epidemiological point of view. Most clinical trials have evaluated HDL-c elevations without studying changes in the functionality of high-density lipoproteins. Additionally, the drugs used to increase HDL-c have limited efficacy as well as unwanted side effects, belong to heterogeneous pharmacological groups with varied metabolic effects, and have sometimes shown deleterious cardiovascular effects. Overall, pharmacological elevation of HDL-c has produced scarce protective cardiovascular effects to date, much lower than those expected from the epidemiological data. HDL-c, a major and elusive target, requires new therapeutic approaches to significantly reduce vascular risk (AU)

[Anaemia predicts mortality in heart failure]. / La anemia es un factor pronóstico de mortalidad en la insuficiencia cardiaca.

BACKGROUND: Anaemia frequently coexists with heart failure. Few studies have examined the impact of anaemia on mortality in this population. OBJECTIVE: To assess the prevalence of anaemia in patients with heart failure in an Internal Medicine Unit and its potential effects on mortality. MATERIAL AND METHODS: We evaluated the electronic medical records of 272 patients with heart failure that fulfilled the criteria admitted to the Internal Medicine Unit of Fundación Hospital Alcorcón (Madrid, Spain)between July and December 2003. Uni and multivariate logistic regression analysis for predictors of mortality. RESULTS: Most patients were women (71%), mean age was 82.1+/-9 years, 106 (39.9%) had anaemia (serum haemoglobin levels<12 g/dL), 69 (25%) had renal failure (serum creatinine levels>1.5 mg/dL and 154 patients (57%) had atrial fibrillation. There were 41 deaths (15%). The frequency of anaemia was higher and the haemoglobin levels were lower in the patients who died (65% vs 36%, and 11.2+/-2.4 g/dL vs 12.6+/-2.1g/dL, p<0.001 for both). Increased serum creatinine was also associated with mortality (1.8+/-0.8 vs 1.3+/-0.8 mg/dL p<0.001). Age, gender, atrial fibrillation or the aetiology of heart failure were not associated with mortality in univariate analysis. In contrast, by multivariate logistic regression analysis, haemoglobin (odds ratio [OR] 0, 78 per g/dL, 95%confidence interval [CI] 0.66- 0.923 p<0.01), New York Heart Association functional classification (OR 2.2, 95% Cl 1.2-3.9 p<0.01), and serum creatinine (OR 1.5 per mg/dL, 95% CI 0.98-2.31 p=0.06) were independent predictors of mortality. CONCLUSIONS: Anaemia is a frequent problem among patients with heart failure and it is a significant independent risk factor for death.

La anemia es un factor pronóstico de mortalidad en la insuficiencia cardiaca / Anaemia predicts mortality in heart failure

Antecedentes: La anemia es frecuente en los enfermos con insuficiencia cardíaca (IC). Son pocos los estudios en los que se valora el impacto de la misma sobre la mortalidad en estos pacientes. Objetivo: Valorar la prevalencia de la anemia entre los enfermos con IC y su posible relación con la mortalidad. Material y métodos: Estudiamos las historias clínicas informatizadas de 272 enfermos que ingresaron en la Unidad de Medicina Interna de la Fundación Hospital Alcorcón con el diagnóstico principal de IC según los criterios de Framingham entre julio y diciembre de 2003. Realizamos análisis de regresión logística uni y multifactorial para valorar los factores pronósticos de mortalidad. Resultados: La mayoría de los enfermos eran mujeres (71%), la edad media fue 82,1 ± 9 años, 106 (39,9%) tenían anemia (niveles de hemoglobina séricos 1,5 mg/dL) y 154 pacientes (57%) tenían fibrilación auricular. Hubo 41 de funciones (15%). La anemia fue más frecuente y los niveles de hemoglobina eran más bajos en los enfermos que fallecieron (65% frente 36% y 11,2 ± 2,4 g/dL frente 12,6 ± 2,1 g/dL, respectivamente, p < 0,001 para ambos). El aumento de los niveles de creatinina séricos también se asociaron con la mortalidad (1,8 ± 0,8 vs 1,3 ± 0,8 mg/dL p < 0,001). En el análisis unifactorial, la edad, el sexo, la fibrilación auricular y la etiología de la IC no se asociaron con la mortalidad. En el análisis de regresión logística multifactorial los factores pronósticos de mortalidad fueron la hemoglobina (odds ratio [OR] 0,78 por g/dL, intervalo de confianza [IC] 95% 0,66-0,923 p < 0,01), la clase functional de la New York Heart Association (OR 2,2, IC 95% 1,2-3,9 p < 0,01) y la creatinina sérica (OR 1,5 por mg/dL, IC 95% 0,98-2,31 p = 0,06). Conclusiones: La anemia es un problema frecuente entre los enfermos con IC y constituye un factor pronóstico independiente de mortalidad

Background: Anaemia frequently coexists with heart failure. Few studies have examined the impact of anaemia on mortality in this population. Objective: To assess the prevalence of anaemia in patients with heart failure in an Internal Medicine Unit and its potential effects on mortality. Material and methods: We evaluated the electronic medical records of 272 patients with heart failure that fulfilled the criteria admitted to the Internal Medicine Unit of Fundación Hospital Alcorcón (Madrid, Spain) between July and December 2003. Uni and multivariate logistic regression analysis for predictors of mortality. Results: Most patients were women (71%), mean age was 82,1 ± 9 years, 106 (39,9%) had anaemia (serum haemoglobin levels 1.5 mg/dL and 154 patients (57%) had atrial fibrillation. There were 41 deaths (15%). The frequency of anaemia was higher and the haemoglobin levels were lower in the patients who died (65% vs 36%, and 11.2 ± 2.4 g/dL vs 12.6 ± 2,1 g/dL, p < 0.001 for both). Increased serum creatinine was also associated with mortality (1.8 ± 0.8 vs 1.3 ± 0.8 mg/dL p < 0.001). Age, gender, atrial fibrillation or the aetiology of heart failure were not associated with mortality in univariate analysis. In contrast, by multivariate logistic regression analysis, haemoglobin (odds ratio [OR] 0,78 per g/dL, 95% confidence interval [CI] 0.66- 0.923 p < 0.01), New York Heart Association functional classification (OR 2.2, 95% CI 1.2-3.9 p < 0.01), and serum creatinine (OR 1.5 per mg/dL, 95% CI 0.98-2.31 p = 0.06) were independent predictors of mortality. Conclusions: Anaemia is a frequent problem among patients with heart failure and it is a significant independent risk factor for death