COVID-19: A Personalized Cardiometabolic Approach for Reducing Complications and Costs. The Role of Aging beyond Topics.

COVID 19 is much more than an infectious disease by SARS-CoV-2 followed by a disproportionate immune response. An older age, diabetes and history of cardiovascular disease, especially hypertension, but also chronic heart failure and coronary artery disease among others, are between the most important risk factors. In addition, during the hospitalization both hyperglycaemia and heart failure are frequent. Less frequent are acute coronary syndrome, arrhythmias and stroke. Accordingly, not all prolonged stays or even deaths are due directly to SARS-CoV-2. To our knowledge, this is the first review, focusing both on cardiovascular and metabolic aspects of this dreadful disease, in an integrated and personalized way, following the guidelines of the Cardiometabolic Health/Medicine. Therefore, current personalized aspects such as ACEIs and ARBs, the place of statins and the most appropriate management of heart failure in diabetics are analysed. Aging, better than old age, as a dynamic process, is also considered in this review for the first time in the literature, and not only as a risk factor attributed to cardiovascular and non-cardiovascular comorbidities. Immunosenescence is also approached to build healthier elders, so they can resist present and future infectious diseases, and not only in epidemics or pandemics. In addition, to do this we must start knowing the molecular mechanisms that underlying Aging process in general, and immunosenescence in particular. Surprisingly, the endoplasmic reticulum stress and autophagy are implicated in both process. Finally, with a training in all the aspects covered in this review, not only the hospital stay, complications and costs of this frightening disease in high-risk population should be reduced. Likely, this paper will open a gate to the future for open-minded physicians.

Characterization of Microvascular Post Occlusive Hyperemia Using Laser Doppler Flowmetry Technique in Subjects With Cardiometabolic Disorders.

INTRODUCTION: Laser Doppler flowmetry (LDF) provides a noninvasive real-time quantification of relative changes in cutaneous perfusion. Assessment of the microvascular function can provide information on the development of various cardiometabolic disorders. In recent years, non-invasive measurements have gain attention, due to the potential complications associated to invasive procedures. OBJECTIVE: To differentiate the microvascular function between subjects with cardiometabolic disorders and healthy controls. METHODS: Evaluation through LDF during post-occlusive reactive hyperemia (PORH) in patients with or without history of cardiometabolic disorders. RESULTS: Peak values of microvascular flow during post-occlusive reactive hyperemia and both upload and recovery slopes were lesser in the pathological group. CONCLUSION: A novel approach to characterize LDF during PORH was useful to differentiate patients with cardiometabolic disorders from healthy subjects.

Iberian Cured-Ham Consumption Improves Endothelial Function in Healthy Subjects.

OBJECTIVES: Previous studies have shown that dietary components such as oleic acid or polyphenols exert beneficial effects on endothelium. We aimed to assess the impact of regular consumption of Iberian cured-ham (ICH) on endothelial function. DESIGN: An open-label, randomized controlled parallel study. SETTING: Volunteers recruited through advertisements at a hospital in Madrid, Spain. PARTICIPANTS: 102 Caucasian adults (76.8% females) aged 25-55 years, and free from cardiometabolic disease. INTERVENTION: Participants were randomized to an ICH-enriched ad libitum diet or an ad libitum diet without ICH for 6 weeks. Subjects in ICH group were randomly provided with either acorn- or mixed-fed ICH, and followed up for an additional 6-week period under their usual diet. MEASUREMENTS: Clinical parameters, biomarkers of endothelial function and oxidative stress, microvascular vasodilatory response to hyperemia and arterial stiffness were measured before and after the intervention. RESULTS: After 6 weeks, a larger decrease in PAI-1 was observed in subjects consuming ICH compared to the Control group (-6.2±17.7 vs. 0.3±1.4 ng/ml; p=0.020). Similarly, microvascular vasodilatory response to hyperemia showed a significant increase (112.4±391.7 vs. -56.0±327.9%; p=0.007). However, neither oxidative stress, hemodynamic nor clinical parameters differed significantly over the study. Additionally, after stopping ICH consumption, improvements in PAI-1 remained for 6 additional weeks with respect to baseline (p=0.006). CONCLUSION: The present study demonstrates, for the first time, that regular consumption of ICH improves endothelial function in healthy adults. Strategies aimed to preserve or improve the endothelial function may have implications in vascular aging beyond the prevention of the atherothrombotic disease.

Eficacia y seguridad de una pauta basal plus con insulina glargina e insulina glulisina en pacientes ancianos de alto riesgo cardiovascular con diabetes mellitus tipo 2 / Safety and efficacy of a basal-plus regimen with insulin glargine and insulin glulisine for elderly patients with high cardiovascular risk and type 2 diabetes mellitus

Objetivos. Evaluar la eficacia y seguridad de una pauta basal plus (BP) con insulina glargina como insulina basal, e insulina glulisina como insulina prandial en la comida principal, en pacientes ancianos con diabetes mellitus tipo 2 (DM2) y alto riesgo cardiovascular, siguiendo la práctica clínica habitual. Pacientes y métodos. Estudio observacional, retrospectivo, realizado en 21 centros de medicina interna en España. Se incluyeron sujetos de edad ≥65 años con DM2, en tratamiento con pauta BP durante 4 a 12 meses antes de la inclusión en el estudio, y diagnóstico de enfermedad cardiovascular o elevado riesgo cardiovascular. La variable principal fue el cambio en la hemoglobina glucosilada (HbA1c) desde la introducción de la glulisina hasta la inclusión en el estudio. Resultados. Se incluyeron 198 pacientes (edad media de 74±6,4 años; hombres: 52%). Tras al menos 4 meses de tratamiento con la pauta BP, iniciada con la adición de glulisina, el valor medio de HbA1c descendió significativamente (9±1,5% vs. 7,7±1,1%; p<0,001) y casi el 24% de los sujetos alcanzaron niveles de HbA1c del 7,5-8%. Asimismo, la glucemia en ayunas descendió significativamente (190,6±73,2mg/dl frente a 138,9±38,2mg/dl; p<0,001). Un total de 35 pacientes (17,7%) presentaron alguna hipoglucemia durante el mes previo al inicio del estudio, y se detectaron 2 casos (1,01%) de hipoglucemia grave. Conclusiones. La estrategia BP podría mejorar significativamente el control glucémico en pacientes ≥65 años con DM2 y alto riesgo cardiovascular, y se asocia a un bajo riesgo de hipoglucemia grave (AU)

Objectives. To assess the safety and efficacy of a basal-plus (BP) regimen with insulin glargine (as basal insulin) and insulin glulisine (as prandial insulin) with the main meal for elderly patients with type 2 diabetes mellitus (DM2) and high cardiovascular risk, following standard clinical practice. Patients and methods. An observational, retrospective study was conducted in 21 centres of internal medicine in Spain. The study included patients aged 65 years or older with DM2, undergoing treatment with a BP regimen for 4 to 12 months before inclusion in the study and a diagnosis of cardiovascular disease or high cardiovascular risk. The primary endpoint was the change in glycated haemoglobin (HbA1c) from the introduction of the glulisine to inclusion in the study. Results. The study included 198 patients (mean age, 74±6.4 years; males, 52%). After at least 4 months of treatment with the BP regimen, started with the addition of glulisine, the mean HbA1c value decreased significantly (9±1.5% vs. 7.7±1.1%; P<.001), and almost 24% of the patients reached HbA1c levels of 7.5-8%. Furthermore, blood glucose levels under fasting conditions decreased significantly (190.6±73.2mg/dl vs. 138.9±38.2mg/dl; P<.001). A total of 35 patients (17.7%) had some hypoglycaemia during the month prior to the start of the study, and 2 cases (1.01%) of severe hypoglycaemia were detected. Conclusions. The BP strategy could significantly improve blood glucose control in patients 65 years of age or older with DM2 and high cardiovascular risk and is associated with a low risk of severe hypoglycaemia (AU)

Safety and efficacy of a basal-plus regimen with insulin glargine and insulin glulisine for elderly patients with high cardiovascular risk and type 2 diabetes mellitus. / Eficacia y seguridad de una pauta basal plus con insulina glargina e insulina glulisina en pacientes ancianos de alto riesgo cardiovascular con diabetes mellitus tipo 2.

OBJECTIVES: To assess the safety and efficacy of a basal-plus (BP) regimen with insulin glargine (as basal insulin) and insulin glulisine (as prandial insulin) with the main meal for elderly patients with type 2 diabetes mellitus (DM2) and high cardiovascular risk, following standard clinical practice. PATIENTS AND METHODS: An observational, retrospective study was conducted in 21 centres of internal medicine in Spain. The study included patients aged 65 years or older with DM2, undergoing treatment with a BP regimen for 4 to 12 months before inclusion in the study and a diagnosis of cardiovascular disease or high cardiovascular risk. The primary endpoint was the change in glycated haemoglobin (HbA1c) from the introduction of the glulisine to inclusion in the study. RESULTS: The study included 198 patients (mean age, 74±6.4 years; males, 52%). After at least 4 months of treatment with the BP regimen, started with the addition of glulisine, the mean HbA1c value decreased significantly (9±1.5% vs. 7.7±1.1%; P<.001), and almost 24% of the patients reached HbA1c levels of 7.5-8%. Furthermore, blood glucose levels under fasting conditions decreased significantly (190.6±73.2mg/dl vs. 138.9±38.2mg/dl; P<.001). A total of 35 patients (17.7%) had some hypoglycaemia during the month prior to the start of the study, and 2 cases (1.01%) of severe hypoglycaemia were detected. CONCLUSIONS: The BP strategy could significantly improve blood glucose control in patients 65 years of age or older with DM2 and high cardiovascular risk and is associated with a low risk of severe hypoglycaemia.

Recomendaciones farmacológicas en la práctica diaria para el control metabólico de la diabetes mellitus tipo 2. Papel de las nuevas insulinas / Pharmacological recommendations in the daily metabolic control of diabetes mellitus type 2. The role of the new insulins

La epidemia de la diabetes tipo 2 a finales del siglo xx y principios del siglo xxi y el reconocimiento de que alcanzar los objetivos específicos del control glucémico puede reducir la morbilidad en dichos pacientes han hecho una prioridad del tratamiento óptimo del control glucémico, así como de los múltiples factores de riesgo cardiovascular tanto clásicos como nuevos. La diabetes es una enfermedad crónica que requiere continuos cuidados médicos y educación del paciente para prevenir complicaciones agudas y reducir el riesgo de complicaciones a largo plazo. El desarrollo de nuevos hipoglucemiantes como las glitazonas, complementando a antidiabéticos clásicos como sulfonilureas y metformina, ha aumentado las opciones orales en el tratamiento de la diabetes mellitus tipo 2. La terapia combinada de dos agentes orales supone el eje esencial en los diabéticos tipo 2. La insulinización precoz dentro de una terapia combinada con antidiabéticos orales es hoy una opción según los Standards de la ADA-2007

The epidemic of type 2 diabetes in the latter part of the 20th and early 21st centuries and the recognition that achieving specific glycemic goals can substantially reduce morbidity, have made effective treatment of hyperglycemia a top priority. In addition, strict control of the multiple, classical and emergent cardiovascular risk factors are also important. Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. The development of new classes of blood glucose-lowering medications such as glitazones to supplement the classical therapies such as sulfonylureas and metformin has increased oral treatment options for type 2 diabetes. Combined therapy of two oral agents is the essential axis of type 2 diabetic patients. Early insulin therapy in combined therapy is presently an option according to ADA-2007 Standards

[Pharmacological recommendations in the daily metabolic control of diabetes mellitus type 2. The role of the new insulins]. / Recomendaciones farmacológicas en la práctica diaria para el control metabólico de la diabetes mellitus tipo 2. Papel de las nuevas insulinas.

The epidemic of type 2 diabetes in the latter part of the 20th and early 21st centuries and the recognition that achieving specific glycemic goals can substantially reduce morbidity, have made effective treatment of hyperglycemia a top priority. In addition, strict control of the multiple, classical and emergent cardiovascular risk factors are also important. Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. The development of new classes of blood glucose-lowering medications such as glitazones to supplement the classical therapies such as sulfonylureas and metformin has increased oral treatment options for type 2 diabetes. Combined therapy of two oral agents is the essential axis of type 2 diabetic patients. Early insulin therapy in combined therapy is presently an option according to ADA-2007 Standards.

Manejo del paciente diabético hospitalizado / Management of diabetes hospitalized patients

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[Raynaud's phenomenon]. / Fenómeno de Raynaud.

Raynaud's phenomenon (RP) is characterized by paroxysmal ischemic crisis of the hands and feet provoked by physical or emotional stimuli. The RP's prevalence is estimated between 4 and 5% of the general population, accompanying or not other conditions, or preceding in years the appearance of various connective tissue diseases. We have to consider, in its pathogenesis, alterations in the vascular tone or intraluminal thromboembolic phenomena. The diagnosis is based on the clinical picture since there are no specific tests to detect primary RP. Therapeutic measures include: change in lifestyle, vasodilator drugs and anti-platelet aggregation drugs, plasmapheresis and surgery. Treatment should be individualized.