Prevention of myocardial dysfunction by Eplerenon in experimental tachycardiomyopathy.

BACKGROUND: High-rate short-duration ventricular pacing induces myocardial hypokinesis that persists once the hemodynamic conditions have been recovered. The aim was to study the factors that determine the persistence of myocardial dysfunction when ventricular tachycardia has ceased and hemodynamic conditions have been restored. MATERIAL/METHODS: An in vivo experimental pig model was used consisting of a ventricular pacing series (n=10), a ventricular pacing and aldosterone blockade (eplerenon) series (n=6), and a control series without ventricular pacing (n=6). Electrical stimulation was performed from the epicardial base of the left ventricle at a frequency 60% above the basal rate for 2 hours followed by a recovery period of 60 minutes. Cardiac and myocardial function parameters were studied. Plasma levels of aldosterone, renin activity, and glutathione were measured. RESULTS: Electrically induced tachycardia produced hemodynamic and myocardial changes that persisted after stimulation had ceased, accompanied by an increase in aldosterone and a coronary flow decrease. These changes were not seen when aldosterone activity was blocked by eplerenon. There was a non-significant elevation in glutathione levels. CONCLUSIONS: These data show that although participation of other neurohormones cannot be ruled out, aldosterone blockade (eplerenon) ameliorates myocardial dysfunction persisting after ventricular tachycardia by preventing coronary endothelial dysfunction.

[Overweight and obesity in hypertensive Spanish patients. The CORONARIA study]. / Sobrepeso y obesidad en pacientes con hipertensión arterial. Estudio CORONARIA.

BACKGROUND AND OBJECTIVE: Obesity is a major and independent cardiovascular risk factor. The aim of this study was to know overweight and obesity distribution in a sample of Spanish high systemic pressure patients (CORONARIA study), the risk factors associated and the calculated cardiovascular risk (CR) that the overweight produces. MATERIAL AND METHOD: 1,720 family physicians included 7,087 hypertensive patients with at least another CR factor associated. Patients were classified depending on their body mass index: its value was < 25 kg/m2 in 1,150 patients; > or = 25 and < 30 kg/m2 in 3,724 (overweight); and > or = 30 kg/m2 in 2,213 patients (obesity). RESULTS: 83.7% of patients showed overweight or obesity; and 36.1% of women included were obese. Overweight was significantly more prevalent in the hypertensive population of Andalucía, Murcia, Canarias and Extremadura, and less frequent than the Spanish mean in Catalonia and Asturias. Hypertensive and obese patients showed higher prevalence of diabetes than normal weight patients (34.3% vs 24%); higher levels of triglycerides; high values of systemic pressure; and lower levels of high density lipoproteins-cholesterol; all these facts raised the CR, calculated value between a 19.7% in the overweight cases and a 11.6% in the obese patients compared with normal weight patients. Heart failure was two times more prevalent in obese patients. CONCLUSIONS: Overweight in hypertensive patients raises the cardiovascular risk by 20%, and has a strong association with diabetes and heart failure.

Sobrepeso y obesidad en pacientes con hipertensión arterial. Estudio CORONARIA / Overweigth and obesity in hypertensive Spanish patients. The CORONARIA study

Fundamento y objetivo: La obesidad es un factor de riesgo mayor e independiente para enfermedad cardiovascular. Hemos estudiado la distribución del sobrepeso y la obesidad en una muestra de pacientes hipertensos de España (estudio CORONARIA), los factores de riesgo que se asocian a ambos y el riesgo cardiovascular (RCV) que el exceso de peso comporta en ellos. Material y método: Un total de 1.720 médicos de atención primaria incluyeron en el estudio a 7.087 pacientes hipertensos y con al menos otro factor de riesgo cardiovascular añadido. Los pacientes se clasificaron según su índice de masa corporal: en 1.150 éste era menor de 25 kg/m2; en 3.724 se situaba entre 25 y 30 kg/m2, y en 2.213 era igual o superior a 30 kg/m2. Resultados: El 83,7% de los pacientes hipertensos estudiados presentaban sobrepeso u obesidad y el 36,1% de las mujeres estudiadas eran obesas. El exceso de peso fue significativamente más prevalente en las poblaciones hipertensas de Andalucía, Murcia, Canarias y Extremadura, y menor que la media nacional en Cataluña y Asturias. En los pacientes hipertensos y obesos destacó el incremento de la prevalencia de diabetes en comparación con los pacientes de peso normal (el 34,3 frente al 24,0%), junto a cifras promedio más altas de triglicéridos, menores de colesterol unido a lipoproteínas de alta densidad y valores más elevados de presión arterial; todos estos factores incrementaron el RCV, calculado entre un 19,7% en el sobrepeso y un 11,6% en la obesidad. En pacientes obesos la prevalencia de insuficiencia cardíaca congestiva se duplicó. Conclusiones: El exceso de peso en los hipertensos supone un incremento adicional del RCV, próximo al 20%, acompañado de una mayor asociación a diabetes e insuficiencia cardíaca congestiva

Background and objective: Obesity is a major and independent cardiovascular risk factor. The aim of this study was to know overweight and obesity distribution in a sample of Spanish high systemic pressure patients (CORONARIA study), the risk factors associated and the calculated cardiovascular risk (CR) that the overweight produces. Material and method: 1,720 family physicians included 7,087 hypertensive patients with at least another CR factor associated. Patients were classified depending on their body mass index: its value was < 25 kg/m2 in 1,150 patients; >= 25 and < 30 kg/m2 in 3,724 (overweight); and >= 30 kg/m2 in 2,213 patients (obesity). Results: 83.7% of patients showed overweight or obesity; and 36.1% of women included were obese. Overweight was significantly more prevalent in the hypertensive population of Andalucía, Murcia, Canarias and Extremadura, and less frequent than the Spanish mean in Catalonia and Asturias. Hypertensive and obese patients showed higher prevalence of diabetes than normal weight patients (34.3% vs 24%); higher levels of triglycerides; high values of systemic pressure; and lower levels of high density lipoproteins-cholesterol; all these facts raised the CR, calculated value between a 19.7% in the overweight cases and a 11.6% in the obese patients compared with normal weight patients. Heart failure was two times more prevalent in obese patients. Conclusions: Overweight in hypertensive patients raises the cardiovascular risk by 20%, and has a strong association with diabetes and heart failure

[Coronary disease risk and prevalence of heart disease in primary care patients with hypertension and renal disease]. / Riesgo coronario y prevalencia de cardiopatías en pacientes hipertensos con afectación renal en asistencia primaria.

INTRODUCTION AND OBJECTIVES: The presence of renal disease significantly alters the cardiovascular risk of patients with high blood pressure. However, few studies have examined renal parameters in primary care patients. The objectives of this study were to investigate cardiovascular risk and the factors influencing it in hypertensive patients with renal disease and to compare the findings with those in hypertensive patients without renal disease. METHODS: The CORONARIA study involved primary care patients with hypertension from all regions of Spain and included two groups with different degrees of renal disease. RESULTS: In total, 703 patients (9.8%) had renal disease. Hypertensive patients with renal disease had a worse cardiovascular risk profile than other hypertensives. The prevalence of diabetes was double in patients with renal disease. Moreover, the risk of a coronary event was significantly higher in those with renal disease. One-third of hypertensives with renal disease had another previously diagnosed cardiovascular disease. In addition, they more frequently had a history of angina, were twice as likely to have had a myocardial infarction, and were more than twice as likely to have undergone revascularization or to have peripheral vascular disease or cerebrovascular disease. Heart failure was four times more frequent in these patients with renal disease than in other hypertensives. CONCLUSIONS: Patients with hypertension and renal disease have a higher risk of cardiovascular disease, exhibit an increased prevalence of diabetes, and suffer from more extensive target organ damage.

Riesgo coronario y prevalencia de cardiopatías en pacientes hipertensos con afectación renal en asistencia primaria / Coronary disease risk and prevalence of heart disease in Primary Care patients with hypertension and renal disease

Introducción y objetivos. La afectación renal supone un cambio importante en la evolución de la enfermedad cardiovascular del hipertenso, pero la frecuencia con que las manifestaciones renales se estudian en el paciente ambulatorio es muy escasa. Se ha estudiado el riesgo cardiovascular y los factores que intervienen en él en una población de hipertensos con afectación renal y se han comparado con los de otros hipertensos. Métodos. En el estudio CORONARIA, realizado en pacientes hipertensos ambulatorios de todas las regiones de España, se incluyeron 2 apartados relativos a los grados de afectación renal. Resultados. Un total de 703 pacientes incluidos (9,8%) presentaban afectación renal. Los hipertensos con afectación renal tuvieron peor perfil de factores de riesgo cardiovascular en comparación con los demás hipertensos. La prevalencia de la diabetes fue el doble en los grupos de pacientes renales. El riesgo de presentar un accidente coronario fue significativamente mayor en los pacientes con afectación renal. Un tercio de los hipertensos con afectación renal tenía otra enfermedad cardiovascular diagnosticada. Además, estos pacientes presentaban una mayor incidencia de angina de pecho, el doble de infartos, y más del doble tenía el antecedente de revascularización o enfermedad vascular periférica y/o cerebral. La insuficiencia cardiaca llegaba a ser 4 veces más frecuente en los pacientes con afectación renal grave que en los otros hipertensos. Conclusiones. Los pacientes hipertensos con afectación renal presentan un riesgo cardiovascular más elevado, una prevalencia mayor de diabetes y una mayor afectación de los órganos diana

Introduction and objectives. The presence of renal disease significantly alters the cardiovascular risk of patients with high blood pressure. However, few studies have examined renal parameters in primary care patients. The objectives of this study were to investigate cardiovascular risk and the factors influencing it in hypertensive patients with renal disease and to compare the findings with those in hypertensive patients without renal disease. Methods. The CORONARIA study involved primary care patients with hypertension from all regions of Spain and included two groups with different degrees of renal disease. Results. In total, 703 patients (9.8%) had renal disease. Hypertensive patients with renal disease had a worse cardiovascular risk profile than other hypertensives. The prevalence of diabetes was double in patients with renal disease. Moreover, the risk of a coronary event was significantly higher in those with renal disease. One-third of hypertensives with renal disease had another previously diagnosed cardiovascular disease. In addition, they more frequently had a history of angina, were twice as likely to have had a myocardial infarction, and were more than twice as likely to have undergone revascularization or to have peripheral vascular disease or cerebrovascular disease. Heart failure was four times more frequent in these patients with renal disease than in other hypertensives. Conclusions. Patients with hypertension and renal disease have a higher risk of cardiovascular disease, exhibit an increased prevalence of diabetes, and suffer from more extensive target organ damage

[Cardiovascular risk in diabetes mellitus and hypertension in Spain. The CORONARIA study]. / Riesgo cardiovascular en diabetes mellitus e hipertensión arterial en España. Estudio CORONARIA.

BACKGROUND AND OBJECTIVE: Diabetes mellitus is a prevalent disease with high cardiovascular mortality. Treatment of risk factors can reduce the associated cardiovascular risk. The CORONARIA study included 7253 patients with high risk systemic hypertension from different regions of Spain. The aim of this study was to analyze the cardiovascular risk (CR) of diabetic patients at baseline and after one-year follow-up. PATIENTS AND METHOD: A total of 2105 (29%) patients with type 2 diabetes and systemic hypertension are included in the CORONARIA study. The CR profile is evaluated at baseline and after treatment of systemic hypertension with amlodipine (5-10 mg), while other cardiovascular risk factors were also treated. Data were compared with non diabetics. RESULTS: Patients with systemic hypertension in Spain show a very high prevalence of diabetes (29%); it is higher in women than men (p<0.05) and higher in secondary prevention than primary prevention (p<0.05). Prevalence diabetes was higher in Murcia, Andalucía, Extremadura and Comunidad Valenciana, and lower in Madrid and País Vasco than the Spanish mean. The CR in primary prevention was significantly higher in diabetics than in non-diabetics (female: 22.9% vs 12.3% in Framingham, and 10.1% vs 5.2% in REGICOR; male: 39.9% vs 27.8% in Framingham and 15.7% vs 10.3% in REGICOR). After one year treatment, cardiovascular risk decreased significantly in both groups of patients, but it did more in diabetics (Framingham: -11.6% vs -6.7%; REGICOR: -5.3% vs -2.8%). CONCLUSIONS: Most patients with diabetes and systemic hypertension did not have an adequate control of CR factors and presented a high cardiovascular risk. Treatment reduced the CR significantly in a greater proportion of diabetic than non diabetic-patients.

Riesgo cardiovascular en diabetes mellitus e hipertensión arterial en España. Estudio CORONARIA / Cardiovascular risk in diabetes mellitus and hypertension in Spain. The CORONARIA study

Fundamento y objetivo: La diabetes mellitus es una enfermedad con una elevada prevalencia y mortalidad cardiovasculares. En el estudio CORONARIA se incluyeron datos de 7.253 pacientes con hipertensión arterial y otro factor de riesgo de las 17 comunidades autónomas. El objetivo de este trabajo es analizar el riesgo cardiovascular (RCV) de los pacientes diabéticos incluidos en el estudio CORONARIA en el momento de su inicio y tras un año de tratamiento de la presión arterial. Pacientes y método: Se ha incluido a 2.105 pacientes con diabetes mellitus tipo 2 e hipertensión arterial mal controlada. El perfil de RCV se evaluó al inicio del estudio y después del tratamiento de la hipertensión (5-10 mg de amlodipino) y otros factores de riesgo durante un año. Los datos se compararon con los de los no diabéticos. Resultados: La prevalencia de la diabetes mellitus en pacientes hipertensos en España es muy alta (29%), mayor en la mujer que en el varón (p < 0,05) y asimismo mayor en prevención secundaria que en primaria (p < 0,05). Es más alta que la media en Murcia, Andalucía, Extremadura y Comunidad Valenciana, e inferior en Madrid y País Vasco. El riesgo basal de enfermedad coronaria en prevención primaria fue significativamente superior en los diabéticos, tanto en mujeres (Framingham: el 22,9 frente al 12,3%; REGICOR: el 10,1 frente al 5,2%) como en varones (Framingham: el 39,9 frente al 27,8%; REGICOR: el 15,7 frente al 10,3%). Tras un año de tratamiento, el RCV disminuyó significativamente en ambos grupos, pero lo hizo más en los diabéticos (Framingham: el ­11,6 frente al ­6,7%; REGICOR: un ­5,3 frente al ­2,8%). Conclusiones: Los pacientes hipertensos diabéticos presentan un RCV aumentado y un peor control de los factores de riesgo. El tratamiento de la presión arterial redujo el riesgo en una proporción mayor que en los no diabéticos

Background and objective: Diabetes mellitus is a prevalent disease with high cardiovascular mortality. Treatment of risk factors can reduce the associated cardiovascular risk. The CORONARIA study included 7253 patients with high risk systemic hypertension from different regions of Spain. The aim of this study was to analyze the cardiovascular risk (CR) of diabetic patients at baseline and after one-year follow-up. Patients and method: A total of 2105 (29%) patients with type 2 diabetes and systemic hypertension are included in the CORONARIA study. The CR profile is evaluated at baseline and after treatment of systemic hypertension with amlodipine (5-10 mg), while other cardiovascular risk factors were also treated. Data were compared with non diabetics. Results: Patients with systemic hypertension in Spain show a very high prevalence of diabetes (29%); it is higher in women than men (p<0.05) and higher in secondary prevention than primary prevention (p<0.05). Prevalence diabetes was higher in Murcia, Andalucía, Extremadura and Comunidad Valenciana, and lower in Madrid and País Vasco than the Spanish mean. The CR in primary prevention was significantly higher in diabetics than in non-diabetics (female: 22.9% vs 12.3% in Framingham, and 10.1% vs 5.2% in REGICOR; male: 39.9% vs 27.8% in Framingham and 15.7% vs 10.3% in REGICOR). After one year treatment, cardiovascular risk decreased significantly in both groups of patients, but it did more in diabetics (Framingham: -11.6% vs -6.7%; REGICOR: -5.3% vs -2.8%). Conclusions: Most patients with diabetes and systemic hypertension did not have an adequate control of CR factors and presented a high cardiovascular risk. Treatment reduced significantly the CR in a greater proportion of diabetic than non diabetic-patients

Mitochondrial changes induced by trimetazidine in the myocardium.

BACKGROUND: The aim was to assess the effect of trimetazidine (TMZ) on mitochondrial alterations induced in a canine model of brief, repeated episodes of ischemia. MATERIAL/METHODS: Twelve crossbred dogs were analyzed, after double-blind randomization, to a 7-day treatment with either TMZ or placebo. Twenty brief, complete occlusions of the left anterior descending coronary artery were performed. Mitochondrial analysis entailed a qualitative (percentage of mitochondrial damage, merging, pairing, vacuoles, and lipofucsin granules) and a quantitative size analysis (major and minor axes, perimeter, and area) of the mitochondria in the ischemic and control zones. RESULTS: Comparative study of the control zones revealed an increase in lipofucsin granules in the TMZ series and a greater percentage of damaged mitochondria and vacuoles. The control-zone mitochondria treated with TMZ presented a significant increase in the perimeter and major axis and a decrease in the minor axis (p<0.005). No significant differences were found between the series in the qualitative analysis of mitochondrial damage in the ischemic zone. The mitochondria in the TMZ series presented a greater major axis and perimeter than those in the placebo series (p<0.05), which presented a smaller minor axis. CONCLUSIONS: TMZ made the mitochondria adopt an elongated, "rod-like" morphology in both the control and ischemic zones. This is interpreted as an increase in the membrane surface. In the non-ischemic zone, TMZ produced an increase in mitochondrial turnover. There were no differences in the myocardium subjected to ischemia in both series in terms of observable mitochondrial damage.