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1.
Maturitas ; 166: 65-85, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36081216

RESUMO

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.


Assuntos
Neoplasias da Mama , Terapia de Reposição de Estrogênios , Menopausa , Feminino , Humanos , Neoplasias da Mama/induzido quimicamente , Terapia de Reposição de Estrogênios/efeitos adversos , Pessoal de Saúde , Sociedades Científicas
2.
Rev Esp Cardiol (Engl Ed) ; 74(5): 438-448, 2021 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33712348

RESUMO

Both cancer treatment and survival have significantly improved, but these advances have highlighted the deleterious effects of vascular complications associated with anticancer therapy. This consensus document aims to provide a coordinated, multidisciplinary and practical approach to the stratification, monitoring and treatment of cardiovascular risk in cancer patients. The document is promoted by the Working Group on Cardio Oncology of the Spanish Society of Cardiology (SEC) and was drafted in collaboration with experts from distinct areas of expertise of the SEC and the Spanish Society of Hematology and Hemotherapy (SEHH), the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Radiation Oncology (SEOR), the Spanish Society of General and Family Physicians (SEMG), the Spanish Association of Specialists in Occupational Medicine (AEEMT), the Spanish Association of Cardiovascular Nursing (AEEC), the Spanish Heart Foundation (FEC), and the Spanish Cancer Association (AECC).


Assuntos
Cardiologia , Doenças Cardiovasculares , Hematologia , Neoplasias , Radioterapia (Especialidade) , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/terapia , Consenso , Fatores de Risco de Doenças Cardíacas , Humanos , Oncologia , Neoplasias/complicações , Neoplasias/epidemiologia , Neoplasias/terapia , Fatores de Risco
3.
Rev Esp Cardiol (Engl Ed) ; 72(10): 813-819, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30971378

RESUMO

INTRODUCTION AND OBJECTIVES: To analyze differences between sexes in the clinical management of patients presenting with symptoms of chest pain and/or palpitations within a population-based study. METHODS: The OFRECE study included a random sample of 8400 individuals from the Spanish population aged 40 years and older; 1132 (13.5%) had previously consulted for chest pain and 1267 (15.1%) had consulted for palpitations and were included in the present study. We calculated both the crude and adjusted odds ratios (OR) of undergoing certain tests and the results of consultations by sex. Adjustment was performed by classic cardiovascular risk factors, a personal history of cardiovascular disease, and a diagnosis of stable angina or atrial fibrillation confirmed in the OFRECE study in each case. RESULTS: No differences were observed in history of consultation for chest pain between women and men (13% vs 14.1%; P=.159) but differences were found in palpitations (19% vs 10.4%, respectively; P <.001). Women who had previously consulted for chest pain underwent fewer echocardiograms (32.5% vs 45.3%, respectively; P <.001), were less frequently referred to a cardiologist (49.1% vs 60.1%; P <.001), were less often admitted to hospital (20.1% vs 39.4%; P <.001), and less frequently received a confirmed diagnosis (60.9 vs 71, 9; P <.001). After full adjustment, all differences decreased and become nonsignificant echocardiograms: adjusted OR, 0.81; 95%CI, 0.60-1.09; referral to a cardiologist: adjusted OR, 0.86; 95%CI, 0.63-1.16; hospital admission: adjusted OR, 0.76; 95%CI, 0.54-1.09). For palpitations, crude differences were smaller and all became nonsignificant after adjustment. CONCLUSIONS: This study does not confirm the existence of sex-related bias in the management of chest pain and palpitations. However, such bias cannot be completely ruled out in diagnoses confirmed within the OFRECE study, which might limit its ability to detect sex-related differences in health care.


Assuntos
Fibrilação Atrial/diagnóstico , Dor no Peito/diagnóstico , Ecocardiografia/métodos , Serviço Hospitalar de Emergência , Encaminhamento e Consulta , Medição de Risco/métodos , Adulto , Idoso , Fibrilação Atrial/epidemiologia , Dor no Peito/epidemiologia , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Fatores Sexuais , Espanha/epidemiologia
4.
Eur Heart J Acute Cardiovasc Care ; 3(3): 237-45, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24842753

RESUMO

AIMS: Assessment of renal function is important for bleeding risk stratification in acute coronary syndrome (ACS). There are three formulas routinely used to assess renal function: the Cockroft-Gault (C-G) formula, the MDRD-4 formula and the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Our aim was to compare the ability of these formulas to predict the risk of in-hospital bleeding in patients with ACS. METHODS: The study included 3270 patients with ACS. The performance of each formula with respect to in-hospital TIMI (Thrombolysis In Myocardial Infarction) major or TIMI minor bleeding were assessed using continuous data and by dividing patients into four subgroups according to the estimated glomerular filtration rate (eGFR): ≥90, 89-60, 30-59 and <30 ml/min/1.73 m(2). RESULTS: Bleeding predictive ability was significantly higher for the C-G formula than for MDRD-4 and CKD-EPI formulas, as evaluated by the area under the curve (AUC); continuous eGFR AUCs: 0.73, 0.69 and 0.71, respectively; categorical eGFR AUCs: 0.71, 0.66 and 0.68, respectively. Net reclassification improvement based on the eGFR categories was significantly positively favored C-G: 9.5% (95% confidence interval (CI) 1.8-17.2%) and 19.1% (95% CI 11.3-26.9%) compared with CKD-EPI and MDRD-4, respectively. After multivariable adjustment, the C-G formula predicted in-hospital bleeding better than MDRD-4 formula (severe renal dysfunction vs. normal renal function: odds ratio 7.98, 95% CI 2.61-24.38 with C-G; odds ratio 3.76, 95% CI 1.63-8.69 with MDRD-4; and odds ratio 5.77, 95% CI 2.18-15.24 with CKD-EPI. CONCLUSIONS: Our findings suggest that the C-G eGFR may improve risk prediction of in-hospital bleeding more than the MDRD-4 equation and the new CKD-EPI equation in patients with ACS.


Assuntos
Síndrome Coronariana Aguda/complicações , Hemorragia/prevenção & controle , Testes de Função Renal/normas , Insuficiência Renal Crônica/fisiopatologia , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Feminino , Taxa de Filtração Glomerular/fisiologia , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/fisiopatologia , Valor Preditivo dos Testes , Insuficiência Renal Crônica/complicações , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/normas
5.
Rev Esp Cardiol ; 63 Suppl 1: 3-16, 2010 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-20223175

RESUMO

This review from the Clinical Cardiology and Outpatient Section of the Spanish Society of Cardiology details recent progress in the field of clinical cardiology. On this occasion, the emphasis is on advances in surface electrocardiography and cardiovascular disease in women. In addition, the review contains a brief overview of those major new developments in therapy that have had the greatest impact on daily clinical practice and summarizes the activities of the Clinical Cardiology and Outpatient Section.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Eletrocardiografia/métodos , Cardiopatias/tratamento farmacológico , Aspirina/uso terapêutico , Quimioterapia Combinada , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Fatores Sexuais
6.
Rev Esp Cardiol ; 61 Suppl 1: 86-96, 2008 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-18341938

RESUMO

Clinical cardiology encompasses all forms of heart disease and their more general characteristics, and its sphere of activity includes practical aspects of prevention, diagnosis, and inpatient and outpatient treatment as applied to patients on an everyday basis. Since certain areas of cardiology have become highly specialized, this review of new developments reported in the past year has attempted to bring together all those advances that are not the subject of research in some particular specialization within cardiology and that have such a wide range of application that they should be familiar to all clinical cardiologists, irrespective of their daily responsibilities. For the purposes of this review, articles were classified according to their origin as either English-language, European, or domestic publications. The review concludes with a summary of registry data collected in the last two years by the Clinical and Outpatient Cardiology Section of the Spanish Society of Cardiology.


Assuntos
Cardiopatias , Europa (Continente) , Cardiopatias/diagnóstico , Cardiopatias/terapia , Humanos , Guias de Prática Clínica como Assunto , Sistema de Registros , Espanha , Estados Unidos
7.
Rev Esp Cardiol ; 60 Suppl 1: 101-10, 2007 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-17352860

RESUMO

This article reviews the main developments reported during the last year concerning metabolic syndrome, population aging, and new atrial fibrillation guidelines. The principal aim was to provide the clinical cardiologist with an overview of recent 2006 publications and conference reports on these topics, which have been selected for their broad clinical implications.


Assuntos
Fibrilação Atrial , Síndrome Metabólica , Dinâmica Populacional , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/terapia , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/terapia , Guias de Prática Clínica como Assunto
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