Riesgo cardiometabólico del sedentarismo / Cardiometabolic risk of sedentary lifestyle

Sedentary behavior is spreading among society, especially since the rise of technology and progress. The sedentary lifestyle habits are being transmitted to young people, who increase the time they spend in sedentary activities like video games or TV. It has been demonstrated that both sedentary behavior and physical inactivity have negative cardiometabolic consequences for the health, and they become a serious problem for public health, as it has been claimed in several studies and by scientific statements. This review intent to make a call of attention to this problem that will have profound impact in the near future in many countries in Latin America. (AU)

El corazón de la mujer / The heart of the women

In the vast majority of cardiovascular diseases (CVDs), there are well-described differences between women and men in epidemiology, pathophysiology, clinical manifestations, effects of therapy, and outcomes. These differences arise on one hand from biological differences among women and men, which are called sex differences, due to differences in gene expression from the sex chromosomes and subsequent differences in sexual hormones leading to differences in gene expression and function in the CV system, In contrast, gender differences are unique to the human. They arise from sociocultural processes, such as different behaviours of women and men; exposure to specific influences of the environment; different forms of nutrition, lifestyle, or stress; or attitudes towards treatments and prevention. The scientific societies are at the forefront of implementing the knowledge in research and healthcare strategies with more proactive attitude for a feminine centered approaches may lead to a more specific and effective use of resources in CVD prevention and therapy in women. (AU)

Pautas de egreso posterior a un episodio de insuficiencia cardíaca aguda / Guidelines rear exit to an episode AHF

A pesar de numerosos ensayos clínicos y guías con los que se cuenta para el manejo de enfermedades cardiovasculares, en ocasiones, este material no es contentivo de directrices explícitas que orienten a los sistemas de salud y al médico especialista o general cómo mejorar la etapa de seguimiento en la consulta externa de la patología. Esto muy probablemente es debido a la falta de respaldo de medicina basada en evidencia para emitir recomendaciones que estandaricen y protocolicen el manejo del paciente ambulatorio como es la regla en muchas condiciones médicas. Se han resumido las recomendaciones para el manejo ambulatorio del paciente luego de un episodio de insuficiencia cardíaca aguda (ICA) basadas en la evidencia científica existente. El objetivo es optimizar las directrices para el control y manejo del paciente que egresa del hospital luego de un episodio de ICA, dando respuestas a preguntas frecuentes. Estas recomendaciones deben redundar en un mejor manejo de estos pacientes con la consecuente reducción de re-hospitalizaciones por igual causa y posposición de la muerte, transformando al paciente ya compensado y egresado en otro con insuficiencia cardiaca crónica “estable”.

Despite numerous published clinical trials, guidelines and statements available for the management of cardiovascular diseases, some do not contain explicit content that may orient health systems, the attending specialist or primary care physician on how to improve the control of such conditions on the follow-up in the outpatient clinic. This could probably be due to the lack of support from evidence based medicine to issue recommendations to standardize ambulatory patient management as is the rule with other medical conditions. Recommendations for the ambulatory management of post acute heart failure (AHF) episode patients are summarized based on existing scientific evidence. The goal is to optimize guidelines for the management and control of discharged patients following an episode of AHF providing answers to frequently raised questions. These recommendations should result in better patient management, consequently reducing re-hospitalization, postponing death and transforming an already compensated and discharged patient into another with “stable” chronic heart failure. We are aware that heart failure management is overly critical due to the fact that, since this entity resides at the final stage of the cardiovascular continuum, it may not spike further interest as compared to other cardiovascular syndromes.

Recuperación renal de la enfermedad hipertensiva / Renal repercutions of hypertensive disease

La enfermedad renal crónica representa una causa mayor de morbilidad y mortalidad y la naturaleza de este fenómeno refleja el hecho de que la misma no existe aisladamente. Más aun, las múltiples comorbilidades y los factores de riesgos concurrentes, comúnmente asociados, hacen difícil su manejo, la intricada y relación bidireccional entre la fisiología cardíaca y renal demanda que ambos sistemas sean tomados en cuenta. Los estudios prospectivos y epidemiológicos han demostrado que la microalbuminuria es predictiva con independencia de los factores tradicionales de riesgo, de la mortalidad total y cardiovascular así como de eventos cardiovasculares dentro del grupo de pacientes con diabetes o hipertensión arterial. La inhibición del sistema renina angiotensina ha demostrado consistentemente reducir o detener el deterioro progresivo de la función renal a través de la reducción en la presión arterial y proteinuria, los dos principales determinantes de la declinación de la función renal. Los beneficios de la inhibición del sistema renina angiotensina por medio de los inhibidores de la enzima de conversión de la angiotensina (IECA), de los bloqueadores del receptor AT1 de angiotensina (BRA), los inhibidores de la renina y los antialdosterónicos han demostrado en múltiples estudios clínicos, a lo largo de diferentes estadios o etapas de enfermedad renal crónica, atenuar la progresión de la enfermedad renal crónica y de insuficiencia cardíaca junto con la disminución de la tasa de mortalidad total, particularmente en los pacientes con enfermedad renal crónica antes de ladiálisis (etapas 1-4).

Chronic kidney disease represents a major cause of morbidity and mortality and the nature of this phenomenon reflects the fact that chronic kidney disease does not exist in isolation. Moreover, the multiple comorbidities and concurrent risk factors commonly associated make optimal management difficult, and the intricate bidireccionally relationship between cardiac and renal physiology demand that both organ systems be addressed. Prospective and epidemiologic studies have shown that microalbuminuria is predictive, independently of traditional risk factors, of all-cause and cardiovascular mortality and CVD events within groups of patients with diabetes or hypertension, and in the general population. Inhibition of the renin angiotensin system has demonstrated consistently to reduce or halt the progressive deterioration of renal function through reduction of blood pressure and proteinuria, the two main determinants of renal function decline. The benefits of angiotensin-convertin genzyme inhibitors or angiotensin AT1 receptor blockers (ARBs), renin inhibitors and anti-aldosteronics have demonstrated in multiple clinical trials across varying degrees of chronic kidney disease an attenuation of progression of chronic kidney disease, reducing new cases heart failure, and lowering rates of all-cause mortality, particularly in pre-dialysis chronic kidney disease patients (stages 1-4).