Trastornos inespecíficos de la repolarización ventricular: un lobo con piel de oveja / Nonspecific ventricular repolarization abnormalities: A wolf in sheep's clothing

El término trastornos inespecíficos de la repolarización ventricular se refiere a un conjunto de alteraciones menores del segmento ST y/o la onda T. Durante mucho tiempo han sido de escaso interés clínico al no traducir diagnósticos específicos. De forma extrema, se ha aseverado que constituyen hallazgos electrocardiográficos benignos. Su presencia se ha reportado en diversos estados patológicos cardiovasculares y no cardiovasculares. Sin embargo, con frecuencia se identifica en personas asintomáticas aparentemente sanas. Un creciente número de estudios demuestran su importancia como predictores de morbimortalidad cardiovascular, expandiendo su espectro hacia la prevención cardiovascular. A la luz de las evidencias científicas acumuladas se impone un cambio en la visión tradicional que se ha tenido con los trastornos inespecíficos de la repolarización ventricular. (AU)

The term nonspecific ventricular repolarization abnormalities refers to a set of minor alterations of the ST segment and/or the T wave. For a long time, they have been of little clinical interest as they do not translate into specific diagnoses. It has even been asserted that they constitute benign electrocardiographic findings. Their presence has been reported in various cardiovascular and non-cardiovascular diseases. However, it is frequently identified in apparently healthy asymptomatic people. A growing number of studies demonstrate their importance as predictors of cardiovascular morbidity and mortality, expanding their spectrum towards cardiovascular prevention. In light of the body of scientific evidence, it is imperative that the traditional view of nonspecific ventricular repolarization abnormalities changes. (AU)

Nonspecific ventricular repolarization abnormalities: A wolf in sheep's clothing.

The term nonspecific ventricular repolarization abnormalities refers to a set of minor alterations of the ST segment and/or the T wave. For a long time, they have been of little clinical interest as they do not translate into specific diagnoses. It has even been asserted that they constitute benign electrocardiographic findings. Their presence has been reported in various cardiovascular and non-cardiovascular diseases. However, it is frequently identified in apparently healthy asymptomatic people. A growing number of studies demonstrate their importance as predictors of cardiovascular morbidity and mortality, expanding their spectrum towards cardiovascular prevention. In light of the body of scientific evidence, it is imperative that the traditional view of nonspecific ventricular repolarization abnormalities changes.

Fenotipos clínicos en el síndrome de apnea obstructiva del sueño / Clinical phenotypes in obstructive sleep apnea

El síndrome de apnea e hipopnea obstructiva del sueño se caracteriza por episodios repetitivos de obstrucción de vía aérea superior y es reconocida cada vez más, como un trastorno heterogéneo y complejo, proponiéndose múltiples fenotipos en base a su mecanismo patogénico, alteraciones polisomnográficas y la presentación clínica. El fenotipo clínico se enfoca en identificar características de un paciente basándose en signos, síntomas, antropometría, comorbilidades, medidas fisiológicas, anatómicas o respuesta al tratamiento. Al ser una enfermedad sub diagnosticada, de alta prevalencia y que produce elevada morbi-mortalidad, se debe estar atento a la pesquisa precoz y en las poblaciones de riesgo. Su diagnóstico se basa en el índice de apnea-hipopnea (IAH) y se requiere un IAH •5 eventos/hora para confirmar el diagnóstico. Sin embargo, cada vez hay más evidencia que el IAH por sí solo es insuficiente para comprender la presentación clínica, respuesta al tratamiento, calidad de vida y mortalidad de los pacientes con apnea del sueño. El fenotipo clínico puede servir de este modo, para entender mejor las diferentes formas de presentación teniendo como finalidad la medicina personalizada con el objetivo de favorecer la conducta terapéutica individualizada. El objetivo de esta revisión es abordar los fenotipos clínicos y proponer una huella digital en los pacientes con apnea del sueño

Obstructive sleep apnea and hypopnea syndrome is characterized by repetitive episodes of upper airway obstruction and is increasingly recognized as a heterogeneous and complex disorder, proposing multiple phenotypes based on its pathogenic mechanism, polysomnographic alterations, and clinical presentation. The clinical phenotype focuses on identifying a patient's characteristics based on signs, symptoms, anthropometry, comorbidities, physiological, anatomical measures or response to treatment. As it is an underdiagnosed disease of high prevalence associated to high morbidity and mortality, we must be alert to early screening and risk populations. Diagnosis is based on the apnea-hypopnea index (AHI) AHI •5 events/hour is required to confirm it, however, there is increasing evidence that AHI alone is insufficient to understand the clinical presentation, the response to treatment, the quality of life and the mortality of patients with sleep apnea. In this way, the clinical phenotype can serve to better understand the different forms of presentation and looks for a personalized medicine that favors an individualized therapeutic behavior. The aim of this review is to address clinical phenotypes and propose a fingerprint in patients with sleep apnea

Major cardiovascular adverse events in Fabry disease patients receiving agalsidase alfa / Eventos cardiovasculares mayores en pacientes con enfermedad de Fabry tratados con agalsidasa alfa

Abstract Cardiovascular mortality (CVM) has become the major contributor to overall Fabry disease (FD) mortality in the enzyme replacement therapy (ERT) era. Our objectives were to describe causes and potential predictors of mortality in FD adult patients in Argentina, and to assess risk of major adverse cardio vascular events (MACE) in the ERT era. We retrospectively studied 93 consecutive patients treated with alpha-galactosidase A (median follow up: 9.5 years from start of ERT). Mean age at ERT starting was 35±16.3 years. Prevalence of cardiomyopathy and renal disease reached 47% and 41%, respectively. Eleven subjects (11.8%, 95%CI: 5-18%) died during follow up (1.24/100 patient-years). Mean overall survival was 71 years (95%CI: 66-75 years). Seven cases were considered as CVM; main causes were sudden death and stroke. Risk of MACE was 14% (95%CI: 6.9-21.1%; 1.47 events/100 patient-years from start of ERT). All but 2 subjects had at least one comorbid cardiovascular risk factor; however, 86% of patients remained free of MACE during follow-up. CVM remained low and our study was underpowered for detection of predictors of mortality, but it is worth noting that age at diagnosis and ERT starting, left ventricular mass index and renal disease trended to correlate with CVM. Prevalence of hypertension, diabetes and dyslipidemia were lower in FD patients when compared to population level data. As in the Argentinean general population, CVM was the leading cause of mortality among this cohort of consecutive FD patients treated with agalsidase alfa.

Resumen La mortalidad cardiovascular (MCV) se ha convertido en el principal contribuyente a la mortalidad general por enfermedad de Fabry (EF) en la era de la terapia de reemplazo enzimático (TRE). Nuestros objetivos fueron describir las causas y posibles predictores de mortalidad en pacientes adultos con EF en la Argentina, y evaluar el riesgo de eventos cardiovasculares mayores (MACE) en la actual era de TRE. Se estudiaron 93 pacientes consecutivos tratados con agalsidasa-alfa por una mediana de 9.5 años tras iniciar TRE. La edad al inicio de TRE fue 35 ± 16.3 años. La prevalencia de cardiomiopatía y enfermedad renal alcanzó 47% y 41%, respectivamente. Once sujetos (11.8%; IC95%: 5-18%) murieron durante el seguimiento (1.24/100 pacientes/año). La supervivencia global fue 71 años (IC95%: 66-75 años). Siete casos fueron considerados como MCV; las principales causas fueron muerte súbita e ictus. El riesgo de MACE fue 14% (IC95%: 6.9-21.1%; 1.47 eventos/100 pacientes/año desde la ERT). Todos menos 2 sujetos tenían al menos un factor de riesgo cardiovascular, pero el 86% permaneció libre de MACE. Los eventos de MCV fueron escasos. El estudio tuvo reducido poder estadístico para detectar predictores de mortalidad, pero la edad al diagnóstico y al iniciar la TRE, índice de masa ventricular izquierda y enfermedad renal tendieron a correlacionarse con MCV. La prevalencia de hipertensión, diabetes y dislipidemia fue menor en comparación con la población general. Como ocurre con la población general en Argentina, los eventos cardiovasculares fueron la principal causa de muerte en esta cohorte de pacientes consecutivos con EF tratados con agalsidasa-alfa.

Metformina y sus efectos cardiovasculares

La enfermedad cardiovascular (ECV) es una de las principales causas de morbi-mortalidad a nivel mundial y produce un enorme gasto económico en la sociedad. Hay múltiples factores de riesgo cardiovascular (CV), entre ellos: el tabaco, la obesidad, la hipertensión arterial, el colesterol y la diabetes mellitus (DM). Esta última se considera como un factor independiente para el desarrollo de ECV y de insuficiencia cardíaca (IC). Como la prevalencia de la DM se va incrementando en el mundo; así lo hace, paralelamente a la IC. Se ha demostrado en estudios preclínicos y clínicos que metformina, un fármaco antidiabético, reduce los eventos CV en los pacientes con DM. La creciente evidencia sugiere que metformina tiene un efecto protector sobre la arteria coronaria más allá de sus efectos hipoglucémicos. Dada su disponibilidad global, vía de administración y costo, metformina proporciona una opción terapéutica alternativa y adicional para la prevención primaria y secundaria de la ECV en DM y no diabéticos por igual. Es una medicación segura con efectos beneficiosos sobre la HbA1c, sobre la reducción de peso y además no produce hipoglucemia cuando es usada como monoterapia. También se sabe que metformina podría tener beneficio terapéutico tanto en la IC con FEVI preservada como en la IC con FEVI reducida. El objetivo de esta revisión es demostrar los beneficios de metformina en la reducción de la ECV, además confirmar su seguridad y protección a nivel CV.

Cardiovascular disease (CVD) is one of the main causes of morbidity and mortality worldwide and produces an enormous economic expense in society. There are multiple cardiovascular (CV) risk factors, including: tobacco, obesity, arterial hypertension, cholesterol, and diabetes mellitus (DM). The latter is considered an independent factor for the development of CVD and heart failure (HF). As the prevalence of DM is increasing in the world; it does so, in parallel with the HF. Metformin, an antidiabetic drug, has been shown in preclinical and clinical studies to reduce CV events in patients with DM. Growing evidence suggests that metformin has a protective effect on the coronary artery beyond its hypoglycemic effects. Given its global availability, route of administration, and cost, metformin provides an additional and alternative therapeutic option for the primary and secondary prevention of CVD in DM and non-diabetics alike. It is a safe medication with beneficial effects on HbA1c, on weight reduction and also does not produce hypoglycemia when used as monotherapy. It is also known that metformin could have therapeutic benefit in both HF with preserved LVEF and HF with reduced LVEF. The objective of this review is to demonstrate the benefits of metformin in reducing CVD, in addition to confirming its safety and protection at the CV level.

As doenças cardiovasculares (DCV) são uma das principais causas de morbimortalidade em todo o mundo e geram um enorme gasto econômico para a sociedade. Existem múltiplos fatores de risco cardiovascular (CV), incluindo: tabaco, obesidade, hipertensão arterial, colesterol e diabetes mellitus (DM). Este último é considerado um fator independente para o desenvolvimento de DCV e insuficiência cardíaca (IC). Como a prevalência de DM está aumentando no mundo; ele o faz, em paralelo com o IC. Metformina, um medicamento antidiabético, demonstrou em estudos pré-clínicos e clínicos reduzir os eventos CV em pacientes com DM. Evidências crescentes sugerem que a metformina tem um efeito protetor na artéria coronária além de seus efeitos hipoglicêmicos. Dada sua disponibilidade global, via de administração e custo, a metformina oferece uma opção terapêutica adicional e alternativa para a prevenção primária e secundária de DCV em DM e não diabéticos. É um medicamento seguro com efeitos benéficos na HbA1c, na redução de peso e também não produz hipoglicemia quando usado em monoterapia. Sabe-se também que metformina pode ter benefício terapêutico tanto na IC com FEVE preservada quanto na IC com FEVE reduzida. O objetivo desta revisão é demonstrar os benefícios de metformina na redução das DCV, além de confirmar sua segurança e proteção em nível de CV.

Predictors of cardiovascular outcomes after surgery in severe tricuspid regurgitation: clinical, imaging and hemodynamic prospective study.

INTRODUCTION AND OBJECTIVES: Severe tricuspid regurgitation (TR) is a prevalent valve disease with a high mortality rate. Current guidelines do not define specific thresholds at which patients should be considered for surgery or percutaneous procedures. Thus, patients are usually referred for intervention at a late stage of the disease. This study aimed to assess predictors of cardiovascular outcomes in a prospective cohort of patients with severe TR referred for surgery. METHODS: This was an observational, prospective, nonrandomized study. All patients underwent surgery for severe TR based on current clinical guidelines. Complete anamnesis, blood test, echocardiogram, cardiovascular magnetic resonance and right and left catheterization were performed. Patients were followed up in the outpatient department and a combined endpoint (hospitalization for heart failure and cardiovascular mortality) was registered. RESULTS: Forty-three consecutive patients were included (age: 66.9 ± 9.6 years, 67.4% female). Tricuspid annuloplasty was performed in all patients. After a median follow-up of 38 months, 12 patients (27.9%) showed the combined endpoint and 7 (16.3%) died. Above all clinical, blood and imaging data, the indexed right ventricular end-diastolic volume constituted the best predictor of the combined endpoint (HR, 1.1; P = .02) and cardiovascular mortality (HR, 1.1; P = .05). Furthermore, indexed right ventricular end-diastolic volume was associated with TR recurrence after surgery, with no impact on clinical outcomes. CONCLUSIONS: In patients with severe TR referred for surgery, right ventricular remodeling assessed by cardiovascular magnetic resonance constituted the best independent predictor of cardiovascular outcomes at follow-up.

[Reduction of red and processed meats in the Spanish population: What is its impact on total and cardiovascular mortality?] / Reducción de carnes rojas y procesadas en la población española: ¿cuál es su impacto sobre la mortalidad cardiovascular?

OBJECTIVE: Quantify the impact of reducing the consumption of red/processed meats on cardiovascular mortality and all-cause mortality of the Spanish adult population based in 5 revisions published. PARTICIPANTS AND MAIN MEASUREMENTS: We defined exposure as consumption of ≥3 servings/week of red or processed meats and considered four possible scenarios of exposed population (30%-60%). Based on data from the Spanish National Statistics Institute, we calculated the weighted mortality between 40 and 80years. Using the relative risks (RR) and 95% confidence intervals (CI) published by the referred revisions (RR=0.88; IC95%: 0.84-0.93 for all-cause mortality and RR=0.92; IC95%: 0.90-0.93 for cardiovascular mortality), we calculated the expected mortality rate in both exposed and unexposed categories. By multiplying these rates by the number of exposed individuals, we estimated the attributable number of yearly deaths. RESULTS: If 60% of the population was exposed, with a 95%CI, the number of cardiovascular deaths that could be averted each year if population consumed <3 servings/week of red or processed meats was between 2.112 and 3.055. If was exposed that 30%, the difference in the yearly number of potentially averted deaths was between 1.079 and 1.577. CONCLUSIONS: Even under the most conservative assumption, the benefit, at the population level, of reducing red or processed meats consumption <3 servings/week on cardiovascular mortality is important. The conclusions of the recently published reviews contradicted their own results and contributed to a state of confusion that can create substantial harm for public health.

Relación entre el consumo habitual de café y la mortalidad general y cardiovascular: revisión de revisiones sistemáticas de la literatura / Relationship between habitual coffee consumption and all-cause and cardiovascular mortality: systematic review of reviews

El objetivo de este estudio fue establecer la relación entre consumo habitual de café y la mortalidad general y cardiovascular. En una búsqueda sistemática en Medline, EMBASE, LILACS y Cochrane se seleccionaron y analizaron revisiones sistemáticas y meta-análisis por una pareja de investigadores. De 181 referencias, 74 fueron seleccionadas por título y resumen; luego de eliminar duplicados y según el puntaje de calidad obtenido por AMSTAR, se consideraron 5 artículos para extracción y análisis. El consumo moderado de café (3 o 4 tazas) disminuye la mortalidad general, tanto comparado con el no consumo (RR= 0,83; IC95%: 0,79-0,88; I2= 83% para 3 tazas, y RR=0,84 IC95%: 0,82-0,87; I2= 58% para 4), como con un consumo mínimo (RR= 0,88; IC95%: 0,84-0,93; I2= 68,7% para 4 tazas, y RR= 0,87; IC95%: 0,83-0,91; I2= 59,8% para consumo entre 3 y 4 tazas). La mortalidad cardiovascular se reduce si se compara con el no consumo, para 4 tazas (RR= 0,80; IC95%: 0,74-0,86; I2= 58%) y (RR= 0,83; IC95%: 0,75-0,92, I2 = 92%) y para 3 tazas (RR= 0,81; IC95%: 0,72-0,90; I2= 92%) y RR (0,79; IC95% 0.74-0.84; I2= 58%). Como conclusión, el consumo habitual de 3 y 4 tazas de café reduce la mortalidad general y cardiovascular.

The objective of this study was to establish the relationship between habitual coffee consumption and all-cause and cardiovascular mortality. A systematic review was conducted using Medline, EMBASE, LILACS and Cochrane databases. Systematic reviews and meta-analysis were selected and analyzed. From 181 systematic reviews, 74 were selected by title and summary; after eliminating duplicates. According to the quality score of the AMSTAR tool, five articles were selected for information extraction and analysis. Moderate coffee consumption (3 or 4 cups) decreased overall mortality, compared to non-consumption (RR= 0.83, 95% CI: 0.79-0.88; I2= 83% for 3 cups, and RR= 0.84, 95% CI: 0.82-0.87; I2= 58% for 4 cups) and minimum consumption (RR= 0.88, 95% CI: 0.84-0.93; I2= 68.7% for 4 cups, and RR= 0.87, 95% CI: 0.83-0.91; I2= 59.8% between 3 and 4 cups). Cardiovascular mortality was reduced when compared to non-consumption, for 4 cups (RR= 0.80, 95% CI: 0.74-0.86; I2= 58%) and (RR= 0.83, 95% CI: 0.75-0.92; I2= 92%), and for 3 cups (RR= 0.81, 95 CI: 0.72-0.90; I2= 92%; RR= 0.79, 95% CI: 0.74-0.84; I2= 58%). In conclusion, habitual coffee consumption between 3 and 4 cups reduces the risk of all-cause and cardiovascular mortality.

Early revascularization and long-term mortality in high-risk patients with non-ST-elevation myocardial infarction. The CARDIOCHUS-HUSJ registry.

INTRODUCTION AND OBJECTIVES: This study sought to analyze the association of early coronary angiography with all-cause mortality and cardiovascular mortality in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) using a large contemporary cohort of patients with NSTEACS from 2 Spanish tertiary hospitals. METHODS: This retrospective observational study included 5673 consecutive NSTEACS patients from 2 Spanish hospitals between 2005 and 2016. We performed propensity score matching to obtain a well-balanced subset of patients with the same probability of undergoing an early strategy, resulting in 3780 patients. Survival analyses were performed by Cox regression models once proportional risk test were verified. RESULTS: Among the study participants, only 2087 patients (40.9%) underwent early invasive coronary angiography. The median follow-up was 59.0 months [interquartile range, 25.0-80.0 months]. All-cause mortality was 19.0%, cardiovascular mortality was 12.8%, and 51.1% patients experienced at least 1 major cardiovascular adverse event in the follow-up. After propensity score matching, the early strategy was associated with significantly lower mortality (hazard ratio: 0.79; 95% confidence interval 0.62-0.98) in high-risk NSTEACS patients. The darly strategy showed a nonsignificant inverse tendency in patients with GRACE score <140. CONCLUSIONS: In high-risk (GRACE score≥ 140) NSTEACS patients in a contemporary real-world registry, early coronary angiography (first 24hours after hospital admission) may be associated with reduced all-cause mortality and cardiovascular mortality at long-term follow-up.

[Air pollution, cardiovascular risk and hypertension]. / Contaminación atmosférica, riesgo cardiovascular e hipertensión arterial.

Air pollution is a worrying factor and has an impact on public health. Multiple studies relate exposure to air pollutants with an increase in cardiovascular events, cardiovascular mortality and mortality for all causes. A relationship has also been demonstrated between increased pollution and high blood pressure, as well as a higher prevalence of hypertension. Pollutants that play a more relevant role in this association are particulate matters, nitrogen dioxide and sulphur dioxide. The objective of this review is to understand the mechanisms involved in this increase and to find the most recent publications that relate pollution, cardiovascular risk and hypertension.

Validity Assessment of Low-risk SCORE Function and SCORE Function Calibrated to the Spanish Population in the FRESCO Cohorts.

INTRODUCTION AND OBJECTIVES: To assess the validity of the original low-risk SCORE function without and with high-density lipoprotein cholesterol and SCORE calibrated to the Spanish population. METHODS: Pooled analysis with individual data from 12 Spanish population-based cohort studies. We included 30 919 individuals aged 40 to 64 years with no history of cardiovascular disease at baseline, who were followed up for 10 years for the causes of death included in the SCORE project. The validity of the risk functions was analyzed with the area under the ROC curve (discrimination) and the Hosmer-Lemeshow test (calibration), respectively. RESULTS: Follow-up comprised 286 105 persons/y. Ten-year cardiovascular mortality was 0.6%. The ratio between estimated/observed cases ranged from 9.1, 6.5, and 9.1 in men and 3.3, 1.3, and 1.9 in women with original low-risk SCORE risk function without and with high-density lipoprotein cholesterol and calibrated SCORE, respectively; differences were statistically significant with the Hosmer-Lemeshow test between predicted and observed mortality with SCORE (P < .001 in both sexes and with all functions). The area under the ROC curve with the original SCORE was 0.68 in men and 0.69 in women. CONCLUSIONS: All versions of the SCORE functions available in Spain significantly overestimate the cardiovascular mortality observed in the Spanish population. Despite the acceptable discrimination capacity, prediction of the number of fatal cardiovascular events (calibration) was significantly inaccurate.

[Use of the CHADS2 score as a predictor of the risk of mortality in hypertensive patients. The FAPRES study]. / Uso de la escala CHADS2 como predictor de riesgo de mortalidad en pacientes hipertensos. El estudio FAPRES.

FOUNDATIONS AND AIM: The aim of this study is to analyze the CHADS2 score as a marker of the risk of mortality in hypertensive patients, with and without the presence of atrial fibrillation. METHODS: We included 1,003 hypertensive patients≥65 years. Risk factors, and CHADS2 score were recorded among other factors, as well as clinical follow-up of number and type of deaths. RESULTS: Mean age was 72.8±5.8 years, and 47.5% were men. During follow-up there were 41 deaths, 20 were of cardiovascular origin. Patients with higher CHADS2 had a higher mortality: 1.5% CHADS2=1; 4.7% in CHADS2=2; 9.1% in CHADS2=3, and 7.8% in CHADS2≥4. CONCLUSIONS: The CHADS2 score can be a clinical instrument of easy application to identify hypertensive patients with a high risk of mortality.

Community-based incidence rate of cardiovascular disease and mortality in 50-75 year old adults.

BACKGROUNDS AND OBJECTIVES: Updated information on the incidence of the principal cardiovascular diseases (CVD) and cardiovascular mortality is not available in Spain. We have studied the incidence rate of new cases of myocardial infarction, heart failure, stroke and cardiovascular mortality in the adult population in Sanlúcar de Barrameda (Spain). MATERIAL AND METHODS: A community-based prospective follow-up study was conducted. The study enrolled 858 participants aged 50-75 years who were randomly selected from the population and followed-up for 5 years. Age and gender-adjusted incidence rates of cardiovascular disease and cardiovascular mortality were calculated, obtaining complete information for 855 participants. Prognostic risk factors of new cases of cardiovascular disease were obtained using Cox proportional hazard modeling. RESULTS: The community-based incidence rate of heart failure was 455/100.000 persons-year. The incidence of myocardial infarction, stroke and cardiovascular mortality (506, 216 and 225/100.000 persons-year, respectively) was also very elevated. Male gender, family history of early cardiovascular disease, diabetes, hypertension and sedentary life style were independent risk factors of cardiovascular disease. CONCLUSIONS: The community-based incidence rate of heart failure in Sanlúcar de Barrameda (Spain) is very high, and it is the first to be reported in Spain. The incidence of myocardial infarction is among the highest in Spain.

Community-based incidence rate of cardiovascular disease and mortality in 50-75 year old adults. / Incidencia poblacional de enfermedad cardiovascular y mortalidad en los adultos de 50-75 años.

BACKGROUNDS AND OBJECTIVES: Updated information on the incidence of the principal cardiovascular diseases (CVD) and cardiovascular mortality is not available in Spain. We have studied the incidence rate of new cases of myocardial infarction, heart failure, stroke and cardiovascular mortality in the adult population in Sanlúcar de Barrameda (Spain). MATERIAL AND METHODS: A community-based prospective follow-up study was conducted. The study enrolled 858 participants aged 50-75 years who were randomly selected from the population and followed-up for 5 years. Age and gender-adjusted incidence rates of cardiovascular disease and cardiovascular mortality were calculated, obtaining complete information for 855 participants. Prognostic risk factors of new cases of cardiovascular disease were obtained using Cox proportional hazard modeling. RESULTS: The community-based incidence rate of heart failure was 455/100.000 persons-year. The incidence of myocardial infarction, stroke and cardiovascular mortality (506, 216 and 225/100.000 persons-year, respectively) was also very elevated. Male gender, family history of early cardiovascular disease, diabetes, hypertension and sedentary life style were independent risk factors of cardiovascular disease. CONCLUSIONS: The community-based incidence rate of heart failure in Sanlúcar de Barrameda (Spain) is very high, and it is the first to be reported in Spain. The incidence of myocardial infarction is among the highest in Spain.

Nuevas consideraciones sobre el control glicémico en pacientes con diabetes tipo 2 y sus implicancias sobre el riesgo cardiovascular / New considerations on glycemic control in patients with type 2 diabetes and its implications on cardiovascular risk

Los resultados de los últimos estudios utilizando una terapia hipoglicemiante intensiva en pacientes con diabetes mellitus tipo 2 han demostrado ser exitosos en el control glicémico de estos pacientes, sin embargo, no han logrado obtener una reducción significativa de la mortalidad por patología cardiovascular.

Ingesta de alimentos de origen animal versus origen vegetal y riesgo cardiovascular / Intake of animal versus vegetable food and cardiovascular risk

Cardiovascular mortality has been associated with changes in lifestyle and food habits. The occidental diet has been characterized by high intake of animal fat and meat, and it is associated whit increased risk of type 2 diabetes and high blood pressure, an increase in levels of markers of endothelial dysfunction, and presence of pro-thrombotic risk factors. We search the Pubmed database and other review references. Inclusion criteria were: papers published after 1999, randomized controled clinical studies, case-control studies, systematic reviews and methanalyses. Vegetarians groups show less cardiovascular morbidity and mortality than non-vegetarians. The evidence indicated that a decreasing intake of red meat, saturate fat, trans fat, and mainly processed meat, and an increase in the intake of whole grain cereals, fruits, vegetables and fish, are associated with a better overall cardiovascular health and survival.

El aumento de la mortalidad cardiovascular en el último tiempo está fuertemente asociado a cambios en los hábitos de alimentación. La dieta occidental caracterizada por una alta ingesta de alimentos de origen animal, presenta mayor riesgo de diabetes tipo 2 (DM 2), hipertensión arterial (HTA), aumento de marcadores de disfunción endotelial y factores protrombóticos. La búsqueda se realizó en la biblioteca online Pubmed y en referencias de otras revisiones. Los criterios de inclusión fueron: artículos de 1999 en adelante, ensayos clínicos aleatorizados-controlados, estudios caso-control, revisiones sistemáticas y meta análisis. En grupos con alto consumo de alimentos de origen vegetal se ha evidenciado una menor morbi-mortalidad cardiovascular, comparado con los grupos con alta ingesta de alimentos de origen animal. La evidencia apoya que la disminución en el consumo de carnes rojas, grasas saturadas y grasas trans, así como el aumento en el consumo de cereales integrales, frutas, vegetales y pescado, disminuye la morbi-mortalidad global y cardiovascular.

Proteina c reaciiva elevada e hipoalbuminemia: indrome/complejo malnutricion, microinflamacion cronica, ateroesclerosis: significado pronostico en pacientes hemodializados / Elevated C reactive protein and hypoalbuminemia. Complex syndrome: malnourishment: chronic microinflamation, atherosclerosis: prognosis significance in patients under hemodyalisis

La mortalidad persiste muy alta en pacientes en hemodiálisis, su principal causa es la cardio-cerebro-vascular seguida de la infecciosa. Existe un estado micro-inflamatorio crónico evidenciado por la elevación de reactantes de fase aguda, entre ellos, la proteína C reactiva, la cual está asociada a la morbi-mortalidad de causa cardiovascular y general en estos enfermos. La hipoalbuminemia es un marcador de malnutrición y un fuerte predictor de todas las causas de morbilidad y mortalidad en hemodiálisis. El objetivo es determinar la posible influencia de la proteína C reactiva y la hipoalbuminemia sobre los resultados de morbimortalidad. Se realizó un estudio observacional analítico, prospectivo, con un seguimiento de 24 meses, cuyo resultado fue un promedio de edad de 46-60 años; el tiempo promedio en hemodiálisis era de 6-16 años. La prevalencia de cifras elevadas de PCR fue de 42,99 %, (IC 95%: 22,42-44,25).Existió una correlación inversa entre las cifras de PCR y la albúmina sérica (r=-0,30; p=0,01) y una correlación directa entre PCR y la edad (r=0,27; p=0,02). El tipo de acceso vascular, (PTFE y catéter), guarda relación con los títulos elevados de PCR (p=0,01). La mayorhospitalización (55,6 %), ocurrió en enfermos con PCR elevada (OR: 2,50, IC95%: 2,02-3,14). La hipoalbuminemia es un predictor independiente de la mortalidad general (OR: 2,44). La PCR constituyó un predictor independiente de mortalidad cardiovascular (OR: 2,76, IC 95%: 2,25-3,61). En conclusión se determina la influencia de la PCR y de la hipoalbuminemia sobre la morbimortalidad en enfermos en hemodiálisis.

Mortality is very hight in patients with end-stage renal disease. The leading cause of death is cardiovascular disease and sepsis. The presence of micro-inflammation, is evidenced by increased levels the acute-phase proteins (C-reactive protein), has been found to be associated with vascular disease in dialysis patients Hypoalbuminemia, ascribed to malnutrition, has been one of the most powerful risk factors that predict all-cause and cardiovascular morbidity and mortality in dialysis patients. The purpose of this study was to describe the prognostic significance in haemodialysis patients with this state. The prospectively study in 107 ESRD patients receiving chronic haemodialysis treatment cohort was then followed-up prospectively for 24 month are formulate. The prevalence of hight PCR are 42,99 %,(22,42-44,25), of hypoalbuminemia 33,33%,(22,42-44,25), were also independently predictive of cardiovascular hospitalization ,hs-CRP (OR: 2,50, IC 95% 2,02-3,14), albumin (OR: 1,50, IC 95% 1,21-2,79), and non cardiovascular hospitalization: tunneled catheter as opposed to a fistula (OR: 11,23, IC 95% 7,42-17,03), hs-CRP (OR: 10,43, IC 95%6,72-16,17), and were also independently predictive of cardiovascular mortality CRP (OR: 2,79, IC 95% 2,25-3,61), non albumin (OR: 0,80, IC 95% 0,70-0,92), and non cardiovascular hospitalization: tunneled catheter as opposed to a fistula (OR: 9,35, IC 95% 6,43- 11,21). Increased in a single circulating inflammatory proteins(hs-CPR) and decreced the albumin levelspredict determine a worse prognosis in hemodialysis patients.

Proteína C reactiva elevada e hipoalbuminemia: síndrome/complejo malnutrición, microinflamación crónica, ateroesclerosis: significado pronóstico en pacientes hemodializados / Elevated C reactive protein and hypoalbuminemia. Complex syndrome: malnourishment. chronic microinflamation, atherosclerosis: prognosis significance in patients under hemodyalisis

La mortalidad persiste muy alta en pacientes en hemodiálisis, su principal causa es la cardio-cerebro-vascular seguida de la infecciosa.Existe un estado micro-inflamatorio crónico evidenciado por la elevación de reactantes de fase aguda, entre ellos, la proteína C reactiva, la cual está asociada a la morbi-mortalidad de causa cardiovascular y general en estos enfermos. La hipoalbuminemia es un marcador de malnutrición y un fuerte predictor de todas las causas de morbilidad y mortalidad en hemodiálisis. El objetivo es determinar la posible influencia de la proteína C reactiva y la hipoalbuminemia sobre los resultados de morbimortalidad. Se realizó un estudio observacional analítico, prospectivo, con un seguimiento de 24 meses, cuyo resultado fue un promedio de edad de 46-60 años; el tiempo promedio en hemodiálisis era de 6-16 años. La prevalencia de cifras elevadas de PCR fue de 42,99 por ciento, (IC 95 por ciento: 22,42-44,25).Existió una correlación inversa entre las cifras de PCR y la albúmina sérica (r=-0,30; p=0,01) y una correlación directa entre PCR y la edad (r=0,27; p=0,02). El tipo de acceso vascular, (PTFE y catéter), guarda relación con los títulos elevados de PCR (p=0,01). La mayorhospitalización (55,6 por ciento), ocurrió en enfermos con PCR elevada (OR: 2,50, IC95 por ciento: 2,02-3,14). La hipoalbuminemia es un predictor independiente de la mortalidad general (OR: 2,44). La PCR constituyó un predictor independiente de mortalidad cardiovascular (OR: 2,76, IC 95 por ciento: 2,25-3,61). En conclusión se determina la influencia de la PCR y de la hipoalbuminemia sobre la morbimortalidad en enfermos en hemodiálisis(AU)

Mortality is very hight in patients with end-stage renal disease. The leading cause of death is cardiovascular disease and sepsis. The presence of micro-inflammation, is evidenced by increased levels the acute-phase proteins (C-reactive protein), has been found to be associated with vascular disease in dialysis patients Hypoalbuminemia, ascribed to malnutrition, has been one of the most powerful risk factors that predict all-cause and cardiovascular morbidity and mortality in dialysis patients. The purpose of this study was to describe the prognostic significance in haemodialysis patients with this state. The prospectively study in 107 ESRD patients receiving chronic haemodialysis treatment cohort was then followed-up prospectively for 24 month are formulate. The prevalence of hight PCR are 42,99 percent,(22,42-44,25), of hypoalbuminemia 33,33 percent, (22,42-44,25), were also independently predictive of cardiovascular hospitalization ,hs-CRP (OR: 2,50, IC 95 percent 2,02-3,14), albumin (OR: 1,50, IC 95 percent 1,21-2,79), and non cardiovascular hospitalization: tunneled catheter as opposed to a fistula (OR: 11,23, IC 95 percent 7,42-17,03), hs-CRP (OR: 10,43, IC 95 percent 6,72-16,17), and were also independently predictive of cardiovascular mortality CRP (OR: 2,79, IC 95 percent 2,25-3,61), non albumin (OR: 0,80, IC 95 percent 0,70-0,92), and non cardiovascular hospitalization: tunneled catheter as opposed to a fistula (OR: 9,35, IC 95 percent 6,43- 11,21). Increased in a single circulating inflammatory proteins(hs-CPR) and decreced the albumin levelspredict determine a worse prognosis in hemodialysis patients(AU)

Influencia de factores de riesgo cardiovascular en el control clínico de la hipertensión arterial / Influence of cardiovascular risk factors on the clinical control of arterial hypertension

Se realizó una investigación clínico-epidemiológica, de cohorte, prospectiva y longitudinal para evaluar la influencia de varios factores de riesgo coronario en el control clínico de la hipertensión arterial. La investigación abarcó el período comprendido entre noviembre de 2000 hasta enero de 2002. La población objeto de estudio estuvo integrada por 120 oficiales diagnosticados de hipertensión arterial esencial y dispensarizados en su puesto médico de salud. Se conformaron 2 grupos de estudio: uno expuesto (n=60) con factores de riesgo de enfermedad cardiovascular y un grupo no expuesto (n=60) de pacientes hipertensos, pero sin otros riesgos concomitantes. Se observaron ambos grupos simultáneamente durante un año, con tomas mensuales para comparar el control de la tensión arterial. Los resultados obtenidos reportan que los factores de riesgo cardiovascular asociados con la hipertensión fueron el sedentarismo, la obesidad, el estrés, el tabaquismo, la hiperlipidemia y la diabetes mellitus. El comportamiento según criterios de control muestra que la tasa de incidencia/100 efectivos de los no controlados fue mayor en el grupo expuesto (56,2/100 efectivos) en relación con el grupo no expuesto (20,0/100 efectivos), con un riesgo relativo de 2,81, lo que confirmó la hipótesis de asociación causal entre ambas variables. La asociación de otros factores de riesgo cardiovascular a la hipertensión arterial influye en el control clínico de la tensión arterial y en su evolución natural, ya que incrementa sustancialmente la probabilidad de eventos cardiovasculares graves que justifican la elevada morbilidad y mortalidad.

A cohort, prospective and longitudinal clinicoepidemiological research was conducted to evaluate the influence of various coronary risk factors in the clinical control of arterial hypertension from November 2000 to January 2002. The population studied was composed of 120 military officers that were diagnosed essential arterial hypertension and categorized at their family physician's office. 2 study groups were organized: one exposed (n=60) with cardiovascular disease risk factors, and a non-exposed group (n=60) of hypertensive patients without other concomitant risks. Both groups were simultaneously observed for a year with monthly readings to compare the control of arterial pressure. The results obtained reported that the cardiovascular risk factors associated with hypertension were sedentarism, obesity, stress, smoking, hyperlipidaemia and diabetes mellitus. The behavior according to the criteria of control showed that the incidence rate/100 individuals of the uncontrolled was higher in the exposed group (56.2/100 individuals) in relation to the nonexposed (20.0/100 individuals) with a relative risk of 2.81, which confirmed the hypothesis of causal association between both variables. The association of other cardiovascular risk factors with arterial hypertension influences on the clinical control of arterial pressure and on its natural evolution, since it significantly increases the probability of severe cardiovascular events that justify the elevated morbidity and mortality.

Activación neurohormonal en la insuficiencia cardiaca congestiva crónica / Neurohormonal activation in chronic congestive heart failure

La insuficiencia cardiaca crónica es un síndrome clínico que aparece tardíamente en la evolución natural de distintas enfermedades cardiacas. Reconoce en la actualidad múltiples mecanismos patogénicos los cuales tienen importancia pronóstica e influyen en su manejo terapéutico. Entre estos mecanismos resaltan la activación de una serie de sistemas neurohormonales como: el sistema nervioso simpático y el sistema renina-angiotensina-aldosterona; estos participan en la perpetuación y progresión de la enfermedad, y ensombrecen la evolución clínica si no son modulados o inhibidos. Se exponen los efectos deletéreos de estos sistemas neurohumorales sobre la anatomía y función cardiovascular y el auténtico círculo vicioso que generan y conducen al fallo cardiaco irreversible y al incremento de la morbilidad y mortalidad, además de analizar los beneficios de fármacos que actúan sobre dichos sistemas.

Chronic heart failure is a clinical syndrome that appears lately in the natural evolution of different heart diseases. At present, multiple pathogenic mechanisms that have a prognostic importance and influence on their therapeutical management are recognized. The activation of a series of neurohormonal systems, such as the sympathetic nervous system and the renin-angiotensin-aldosterone system stand out among these mechanisms They participate in the perpetuation and progression of the disease and shadow the clinical evolution if they are not modulated or inhibited. The deleterious effects of these neurohormonal systems on the anatomy and cardiovascular function and the authentic vicious circle they generate are dealt with. They lead to an irreversible heart failure and to the increase of morbidity and mortality. The benefits of the drugs acting on these systems are also analyzed.