SEA 2024 Standards for Global Control of Vascular Risk. / Estándares de la Sociedad Española de Arteriosclerosis 2024 para el control global del riesgo vascular.

One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to the knowledge, prevention and treatment of vascular diseases, which are the leading cause of death in Spain and entail a high degree of disability and health expenditure. Atherosclerosis is a multifactorial disease and its prevention requires a global approach that takes into account the associated risk factors. This document summarises the current evidence and includes recommendations for patients with established vascular disease or at high vascular risk: it reviews the symptoms and signs to evaluate, the laboratory and imaging procedures to request routinely or in special situations, and includes the estimation of vascular risk, diagnostic criteria for entities that are vascular risk factors, and general and specific recommendations for their treatment. Finally, it presents aspects that are not usually referenced in the literature, such as the organisation of a vascular risk consultation.

Olmesartan-induced enteropathy associated with antiphospholipid syndrome.

Olmesartan-induced enteropathy (OIE) is an emergent enteropathy related to this angiotensin II receptor blocker. Main clinical manifestation is chronic diarrhea and duodenal biopsy is characterized by villous atrophy. Therefore, it is necessary to exclude other causes of enteropathy such as celiac disease, autoimmune enteropathy, intestinal lymphoma, parasitic infections, immunodeficiencies, or Crohn disease. Although it is supposed to be triggered by an immune mechanism, it is not clear its relation to other autoimmune disorders. We report for the first time a case of OIE associated with antiphospholipid syndrome.

Safety of SGLT2 inhibitors in very elderly diabetic type 2 patients in real life / Seguridad de los inhibidores de SGLT2 en pacientes diabéticos tipo 2 muy ancianos en la vida real

Introduction: Sodium glucose cotransporter 2 inhibitors (SGLT2i) are the latest antidiabetic treatments that reduces mortality and cardiovascular outcomes. Its use in real life in very elderly patients is limited by its possible side effects.Material and methods: We conducted a retrospective study of patients treated with SGLT2i in our community (La Rioja) since 2014. The safety (adverse effects) and prognosis (mortality, cardiac decompensation, and cardiovascular events) during the first 24 months of treatment were evaluated.Results: We included 235 patients treated with SGLT2i, 114 of them were men (48.5%), and the mean age was 79.6 ± 3.9 years. The most used SGLT2i was empagliflozin (55.7%). The mean Hb1Ac at the time of inclusion was 7.9 ± 1.4, showing a decrease in 47.7% of the included patients during the follow up. The initial values of creatinine and glomerular filtration rate at the time of inclusion (0.94 ± 0.3 and 68.3 ± 16.4) presented an improvement at 24 months of treatment (0.94 ± 0.27 and 68.2 ± 15.8). During follow-up, 94 adverse events were described in 84 patients, and 53 treatment suspensions. This adverse events were related with sex (p 0.004), dapagliflozin (p < 0.001) and initial Hb1Ac values (p 0.04). The most common adverse event were genitourinary infections (63), followed by acute kidney injury (9), being the latter the most frequent cause of treatment interruption. Symptomatic hypoglycaemia during the follow-up was related with treatment of insulin, age and Hb1Ac (p <0.01).Conclusions: Treatment with SGLT2i is a safe and well-tolerated treatment in very elderly patients in real life. Genitourinary infections are the most common adverse events, but those that less frequently cause treatment interruption. (AU)

Introducción: Los inhibidores del cotransportador de sodio y glucosa tipo 2 (SGLT2i) son los últimos tratamientos antidiabéticos que reducen la mortalidad y los resultados cardiovasculares. Su uso en la vida real en pacientes muy ancianos está limitado por sus posibles efectos secundarios.Material y métodos: Realizamos un estudio retrospectivo de pacientes tratados con iSGLT2 en nuestra comunidad (La Rioja) desde 2014. La seguridad (efectos adversos) y el pronóstico (mortalidad, descompensación cardiaca y eventos cardiovasculares) durante los primeros 24 meses de tratamiento fueron evaluado.Resultados: Se incluyeron 235 pacientes tratados con SGLT2i, 114 de ellos hombres (48,5%) y la edad media fue de 79,6 ± 3,9 años. El SGLT2i más utilizado fue la empagliflozina (55,7%). La Hb1Ac media en el momento de la inclusión fue de 7,9 ± 1,4, mostrando un descenso en el 47,7% de los pacientes incluidos durante el seguimiento. Los valores iniciales de creatinina y filtrado glomerular en el momento de la inclusión (0,94 ± 0,3 y 68,3 ± 16,4) presentaron una mejoría a los 24 meses de tratamiento (0,94 ± 0,27 y 68,2 ± 15,8). Durante el seguimiento se describieron 94 eventos adversos en 84 pacientes y 53 suspensiones del tratamiento. Estos eventos adversos se relacionaron con el sexo (p 0,004), dapagliflozina (p < 0,001) y valores iniciales de Hb1Ac (p 0,04). El evento adverso más frecuente fueron las infecciones genitourinarias (63), seguidas de la insuficiencia renal aguda (9), siendo esta última la causa más frecuente de interrupción del tratamiento. La hipoglucemia sintomática durante el seguimiento se relacionó con el tratamiento de insulina, la edad y la Hb1Ac (p <0,01).Conclusiones: El tratamiento con SGLT2i es un tratamiento seguro y bien tolerado en pacientes muy ancianos en la vida real. Las infecciones genitourinarias son los eventos adversos más frecuentes, pero los que con menor frecuencia provocan la interrupción del tratamiento. (AU)

Estándares SEA 2022 para el control global del riesgo cardiovascular / SEA 2022 Standards for Global Control of Cardiovascular Risk

La Sociedad Española de Arteriosclerosis tiene entre sus objetivos contribuir al mayor y mejor conocimiento de la enfermedad vascular, su prevención y su tratamiento. Es de sobra conocido que las enfermedades cardiovasculares son la primera causa de muerte en nuestro país y conllevan además un elevado grado de discapacidad y gasto sanitario. La arteriosclerosis es una enfermedad de causa multifactorial y es por ello que su prevención exige un abordaje global que contemple los distintos factores de riesgo con los que se asocia. Así, este documento resume el nivel actual de conocimientos e incluye recomendaciones y procedimientos a seguir ante el paciente que presenta enfermedad cardiovascular establecida o se encuentra con elevado riesgo vascular. En concreto, este documento revisa los principales síntomas y signos a evaluar durante la visita clínica, los procedimientos de laboratorio y de imagen a solicitar de forma rutinaria o aquellos en situaciones especiales. Igualmente, incluye la estimación del riesgo vascular, los criterios diagnósticos de las distintas entidades que son factores de riesgo cardiovascular, plantea recomendaciones generales y específicas para el tratamiento de los distintos factores de riesgo cardiovascular y sus objetivos finales. Por último, el documento recoge aspectos habitualmente poco referenciados en la literatura como son la organización de una consulta de riesgo vascular. (AU)

One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known that cardiovascular diseases are the leading cause of death in our country and entail a high degree of disability and health care costs. Arteriosclerosis is a multifactorial disease and therefore its prevention requires a global approach that takes into account the different risk factors with which it is associated. Therefore, this document summarizes the current level of knowledge and includes recommendations and procedures to be followed in patients with established cardiovascular disease or at high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or requested for those in special situations. It also includes vascular risk estimation, the diagnostic criteria of the different entities that are cardiovascular risk factors, and makes general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not usually referenced in the literature, such as the organization of a vascular risk consultation. (AU)

Rabdomiólisis: un síndrome a tener en cuenta / Rhabdomyolysis: A syndrome to be considered

La rabdomiólisis es una entidad clínica caracterizada por la liberación de elementos intracelulares tras la destrucción del músculo esquelético. La tríada clásica se caracteriza por la presencia de dolor muscular, debilidad y orina oscura, asociada a elevación de la creatincinasa (CK). Las causas relacionadas con este síndrome son variadas, siendo la etiología traumática, inmovilización, sepsis, drogas, fármacos y alcohol, las más frecuentes. Los valores de CK son utilizados como diagnóstico y pronóstico, siendo la disfunción renal la complicación más grave. El tratamiento se basa en la fluidoterapia intensiva y precoz para evitar complicaciones renales. (AU)

Rhabdomyolysis is characterized by the release of intracellular elements after the destruction of skeletal muscle. Is characterized by the presence of muscle pain, weakness, and dark urine, associated with elevated creatine kinase (CK). The causes related to this syndrome are varied, being traumatic etiology, immobilization, sepsis, drugs and alcohol the most frequent. CK values are used for diagnosis and prognosis, being renal dysfunction the most serious complication. Treatment is based on early and intensive fluid therapy to avoid kidney complications. (AU)

SEA 2022 Standards for Global Control of Cardiovascular Risk. / Estándares SEA 2022 para el control global del riesgo cardiovascular.

One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known that cardiovascular diseases are the leading cause of death in our country and entail a high degree of disability and health care costs. Arteriosclerosis is a multifactorial disease and therefore its prevention requires a global approach that takes into account the different risk factors with which it is associated. Therefore, this document summarizes the current level of knowledge and includes recommendations and procedures to be followed in patients with established cardiovascular disease or at high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or requested for those in special situations. It also includes vascular risk estimation, the diagnostic criteria of the different entities that are cardiovascular risk factors, and makes general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not usually referenced in the literature, such as the organization of a vascular risk consultation.

[Rhabdomyolysis: A syndrome to be considered]. / Rabdomiólisis: un síndrome a tener en cuenta.

Rhabdomyolysis is characterized by the release of intracellular elements after the destruction of skeletal muscle. Is characterized by the presence of muscle pain, weakness, and dark urine, associated with elevated creatine kinase (CK). The causes related to this syndrome are varied, being traumatic etiology, immobilization, sepsis, drugs and alcohol the most frequent. CK values are used for diagnosis and prognosis, being renal dysfunction the most serious complication. Treatment is based on early and intensive fluid therapy to avoid kidney complications.

Relationship between nutritional status and length of hospital stay among patients with atrial fibrillation - a result of the nutritional status heart study.

Background: Nutritional status is related to the prognosis and length of hospital stay (LOHS) of patients with atrial fibrillation (AF). This study aimed to assess how nutritional status affects LOHS for patients with AF. Methods: We performed retrospective analysis of the medical records of 1,813 patients admitted urgently with a diagnosis of AF to the Institute of Heart Diseases of the University Clinical Hospital in Wroclaw, Poland. Results: In total, 1,813 patients were included in the analysis. The average LOHS in the entire group was 3.53 ± 3.41 days. The mean BMI was 28.7 kg/m2 (SD: 5.02). Patients who were hospitalized longer were statistically more likely to have a Nutritional Risk Score (NRS) ≥3 (p = 0.028). A higher percentage of longer hospitalized patients with LDL levels below 70 mg/dl (p < 0.001) and those with HDL ≥40 mg/dl (p < 0.001) were observed. Study participants with NRS ≥3 were an older group (M = 76.3 years), with longer mean LOHS (M = 4.44 days). The predictors of LOHS in the univariate model were age (OR = 1.04), LDL (OR = 0.99), HDL (OR = 0.98), TC (OR = 0.996), CRP (OR = 1, 02, p < 0.001), lymphocytes (OR = 0.97, p = 0.008) and in the multivariate model were age, LDL (mg/dl), HDL (mg/dl), Na, and K. Conclusion: For nutritional status, factors indicating the risk of prolonged hospitalization in patients with AF are malnutrition, lower serum LDL, HDL, potassium, and sodium levels identified at the time of admission to the cardiology department. Assessment of nutritional status in patients with AF is important both in the context of evaluating obesity and malnutrition status, as both conditions can alter the prognosis of patients. Further studies are needed to determine the exact impact of the above on the risk of prolonged hospitalization.